Provider Demographics
NPI:1497856801
Name:COLUMBUS ANESTHESIA PC
Entity Type:Organization
Organization Name:COLUMBUS ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:JEFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-342-1050
Mailing Address - Street 1:4401 S 650 W
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-1548
Mailing Address - Country:US
Mailing Address - Phone:812-342-1050
Mailing Address - Fax:812-342-9620
Practice Address - Street 1:4401 S 650 W
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-1548
Practice Address - Country:US
Practice Address - Phone:812-342-1050
Practice Address - Fax:812-342-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50001451A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC24197Medicare UPIN
IN054970AMedicare ID - Type Unspecified