Provider Demographics
NPI:1508935370
Name:COLUMBUS CARDIOLOGY P C
Entity Type:Organization
Organization Name:COLUMBUS CARDIOLOGY P C
Other - Org Name:INDIANA HEART PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:PREUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-379-2020
Mailing Address - Street 1:2325 18TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5387
Mailing Address - Country:US
Mailing Address - Phone:812-379-2020
Mailing Address - Fax:812-378-8267
Practice Address - Street 1:2325 18TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5387
Practice Address - Country:US
Practice Address - Phone:812-379-2020
Practice Address - Fax:812-378-8267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003293A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN054770Medicare ID - Type Unspecified
IN192390Medicare ID - Type Unspecified