Provider Demographics
NPI:1275588386
Name:COLUMBIA MEDICAL CENTER LTD
Entity Type:Organization
Organization Name:COLUMBIA MEDICAL CENTER LTD
Other - Org Name:MEDICAL ASSOCIATES OF HIGHLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WADDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:AHDAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-937-2511
Mailing Address - Street 1:9696 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2909
Mailing Address - Country:US
Mailing Address - Phone:219-937-2511
Mailing Address - Fax:219-937-2522
Practice Address - Street 1:9696 GORDON DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2909
Practice Address - Country:US
Practice Address - Phone:219-937-2511
Practice Address - Fax:219-937-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200114330AMedicaid
133710Medicare ID - Type Unspecified