Provider Demographics
NPI:1245791581
Name:DEDICATED COLUMBUS OHIO, LLC
Entity Type:Organization
Organization Name:DEDICATED COLUMBUS OHIO, LLC
Other - Org Name:DEDICATED SENIOR MEDICAL CENTER WEST BROAD ST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-628-6117
Mailing Address - Street 1:50 NORTH WILSON ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204
Mailing Address - Country:US
Mailing Address - Phone:614-702-7915
Mailing Address - Fax:305-393-5989
Practice Address - Street 1:50 NORTH WILSON ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204
Practice Address - Country:US
Practice Address - Phone:614-702-7915
Practice Address - Fax:305-393-5989
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEDICATED COLUMBUS OHIO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-28
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site