Provider Demographics
NPI:1659374825
Name:UROLOGY CENTER OF COLUMBUS, LLC
Entity Type:Organization
Organization Name:UROLOGY CENTER OF COLUMBUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORD. CLINICAL ADMIN SRVCS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-324-7700
Mailing Address - Street 1:1021 TALBOTTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8744
Mailing Address - Country:US
Mailing Address - Phone:706-324-7700
Mailing Address - Fax:706-596-5810
Practice Address - Street 1:1021 TALBOTTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8744
Practice Address - Country:US
Practice Address - Phone:706-324-7700
Practice Address - Fax:706-596-5810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009060174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4927Medicare ID - Type UnspecifiedUROLOGY CTR OF COLS LLC
GA4760880001Medicare NSC