Provider Demographics
NPI:1245392430
Name:INTERNISTS, INC.
Entity Type:Organization
Organization Name:INTERNISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:CONGBALAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-291-0022
Mailing Address - Street 1:985 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3109
Mailing Address - Country:US
Mailing Address - Phone:614-291-0022
Mailing Address - Fax:614-291-6687
Practice Address - Street 1:985 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3109
Practice Address - Country:US
Practice Address - Phone:614-291-0022
Practice Address - Fax:614-291-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033387207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0224724Medicaid
OHA73956Medicare UPIN
OHCO0372804Medicare ID - Type UnspecifiedDR.C