Provider Demographics
NPI:1508949710
Name:GREATER COLUMBUS OTOLARYNGOLOGY, HEAD AND NECK SURGERY, INC.
Entity Type:Organization
Organization Name:GREATER COLUMBUS OTOLARYNGOLOGY, HEAD AND NECK SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MECHENBIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-461-0008
Mailing Address - Street 1:839 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1416
Mailing Address - Country:US
Mailing Address - Phone:614-461-0008
Mailing Address - Fax:614-461-6076
Practice Address - Street 1:839 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1416
Practice Address - Country:US
Practice Address - Phone:614-461-0008
Practice Address - Fax:614-461-6076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032588207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0739811Medicaid
OHCA1803OtherRAILROAD MEDICARE
OH9928861Medicare PIN
OHCA1803OtherRAILROAD MEDICARE