Provider Demographics
NPI:1316001183
Name:COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.
Other - Org Name:PRIMARYONE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIGID
Authorized Official - Middle Name:L
Authorized Official - Last Name:EVERHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-645-5500
Mailing Address - Street 1:2780 AIRPORT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2289
Mailing Address - Country:US
Mailing Address - Phone:614-859-1906
Mailing Address - Fax:614-645-5517
Practice Address - Street 1:3781 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-4011
Practice Address - Country:US
Practice Address - Phone:614-645-3163
Practice Address - Fax:614-645-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QF0400X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2051185Medicaid
OH3618691OtherMEDICARE #
OH36D0861124OtherCLIA