Provider Demographics
NPI:1467906701
Name:CAREATC-CITY OF COLUMBUS-14249-065
Entity Type:Organization
Organization Name:CAREATC-CITY OF COLUMBUS-14249-065
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF PURCHASING AND FACILITIES
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUCWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-779-7416
Mailing Address - Street 1:2000 10TH AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 10TH AVE STE 410
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3714
Practice Address - Country:US
Practice Address - Phone:706-653-4616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care