Provider Demographics
NPI:1659681120
Name:MOUNT CARMEL HEALTH PROVIDERS III, LLC
Entity Type:Organization
Organization Name:MOUNT CARMEL HEALTH PROVIDERS III, LLC
Other - Org Name:MOUNT CARMEL HEALTH STATIONS AT CHURCH FOR ALL PEOPLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-546-4969
Mailing Address - Street 1:6150 EAST BROAD STREET
Mailing Address - Street 2:2ND FLOOR WH 233
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1574
Mailing Address - Country:US
Mailing Address - Phone:614-546-4400
Mailing Address - Fax:
Practice Address - Street 1:946 PARSONS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-2346
Practice Address - Country:US
Practice Address - Phone:614-445-6275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH93262671Medicare PIN