Provider Demographics
NPI:1497822548
Name:COLUMBIA MULTI SPECIALTY CLINIC PLLC
Entity Type:Organization
Organization Name:COLUMBIA MULTI SPECIALTY CLINIC PLLC
Other - Org Name:CMSMC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:INDU
Authorized Official - Middle Name:
Authorized Official - Last Name:BALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-388-9388
Mailing Address - Street 1:1394 HATCHER LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3586
Mailing Address - Country:US
Mailing Address - Phone:931-388-9388
Mailing Address - Fax:931-388-9808
Practice Address - Street 1:1394 HATCHER LN
Practice Address - Street 2:SAME
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3586
Practice Address - Country:US
Practice Address - Phone:931-388-9388
Practice Address - Fax:931-388-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN LIC # 31656207QA0505X
207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4059771Medicaid
TN4059771Medicaid
=========OtherTAX ID FED
BB3839315OtherDEA FED
TN3376405Medicare PIN