Provider Demographics
NPI:1437272127
Name:KNIGHTSBRIDGE INTERNAL MEDICINE & CARDIOLOGY, INC.
Entity Type:Organization
Organization Name:KNIGHTSBRIDGE INTERNAL MEDICINE & CARDIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-451-2174
Mailing Address - Street 1:4830 KNIGHTSBRIDGE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2300
Mailing Address - Country:US
Mailing Address - Phone:614-451-2174
Mailing Address - Fax:614-451-1742
Practice Address - Street 1:4830 KNIGHTSBRIDGE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2300
Practice Address - Country:US
Practice Address - Phone:614-541-2174
Practice Address - Fax:614-451-1742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0922274Medicaid
OHKN9923651Medicare ID - Type Unspecified