Provider Demographics
NPI:1639279045
Name:CENTRAL OHIO PRIMARY CARE PHYSICIANS, INC.
Entity Type:Organization
Organization Name:CENTRAL OHIO PRIMARY CARE PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEEP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-326-2672
Mailing Address - Street 1:400 ALTAIR PKWY STE 4300
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7654
Mailing Address - Country:US
Mailing Address - Phone:614-326-5665
Mailing Address - Fax:614-273-0540
Practice Address - Street 1:400 ALTAIR PKWY STE 4300
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7654
Practice Address - Country:US
Practice Address - Phone:614-326-5665
Practice Address - Fax:614-273-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2137388Medicaid
OHCED368631Medicare PIN