Provider Demographics
NPI:1629262779
Name:COLUMBUS, RENEE ANN (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:RENEE
Middle Name:ANN
Last Name:COLUMBUS
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:165 PLANK ROAD
Mailing Address - City:VINTONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15961-0205
Mailing Address - Country:US
Mailing Address - Phone:814-322-8916
Mailing Address - Fax:814-946-4970
Practice Address - Street 1:810 VALLEY VIEW BOULEVARD
Practice Address - Street 2:BLAIR GASTROENTEROLOGY ASSOCIATES
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6342
Practice Address - Country:US
Practice Address - Phone:814-946-5469
Practice Address - Fax:814-946-4970
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2008-12-18
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Provider Licenses
StateLicense IDTaxonomies
PAMA053033363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
117268E81Medicare PIN