Provider Demographics
NPI:1518095520
Name:COLUMBUS PULMONARY AND CRITICAL CARE, LLC
Entity Type:Organization
Organization Name:COLUMBUS PULMONARY AND CRITICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ST JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-224-0093
Mailing Address - Street 1:745 W STATE ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222
Mailing Address - Country:US
Mailing Address - Phone:614-224-0093
Mailing Address - Fax:614-221-5480
Practice Address - Street 1:745 W STATE ST
Practice Address - Street 2:SUITE 610
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222
Practice Address - Country:US
Practice Address - Phone:614-224-0093
Practice Address - Fax:614-221-5480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054825207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DH0842OtherRAILROAD MEDICARE
OH2873878Medicaid
DH0842OtherRAILROAD MEDICARE
OHCO9328161Medicare ID - Type Unspecified