Provider Demographics
NPI:1356855852
Name:THE COLUMBUS ORTHOPAEDIC CLINIC, P.A.
Entity Type:Organization
Organization Name:THE COLUMBUS ORTHOPAEDIC CLINIC, P.A.
Other - Org Name:THE COLUMBUS ORTHOPAEDIC CLINIC, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-370-1014
Mailing Address - Street 1:225 TOMLINSON DR
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-7734
Mailing Address - Country:US
Mailing Address - Phone:662-498-1240
Mailing Address - Fax:662-338-9490
Practice Address - Street 1:225 TOMLINSON DR
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-7734
Practice Address - Country:US
Practice Address - Phone:662-498-1240
Practice Address - Fax:662-338-9490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COLUMBUS ORTHOPAEDIC CLINIC, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-21
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies