Provider Demographics
NPI:1578584397
Name:MOUNT CARMEL HEALTH PLAN, INC
Entity Type:Organization
Organization Name:MOUNT CARMEL HEALTH PLAN, INC
Other - Org Name:MEDIGOLD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-546-3227
Mailing Address - Street 1:6150 E BROAD ST
Mailing Address - Street 2:EE320
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1574
Mailing Address - Country:US
Mailing Address - Phone:614-546-3227
Mailing Address - Fax:614-546-3136
Practice Address - Street 1:6150 E BROAD ST
Practice Address - Street 2:EE320
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1574
Practice Address - Country:US
Practice Address - Phone:614-546-3227
Practice Address - Fax:614-546-3136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization