Provider Demographics
NPI: | 1669504387 |
---|---|
Name: | MOUNT CARMEL HEALTH SYSTEM |
Entity Type: | Organization |
Organization Name: | MOUNT CARMEL HEALTH SYSTEM |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR, EMPLOYER SERVICES |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TARA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JOHNSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 614-546-4365 |
Mailing Address - Street 1: | 6150 E BROAD ST |
Mailing Address - Street 2: | 2ND FLOOR, EB 239B |
Mailing Address - City: | COLUMBUS |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43213-1574 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 614-546-4621 |
Mailing Address - Fax: | 614-546-4536 |
Practice Address - Street 1: | 5969 E BROAD ST |
Practice Address - Street 2: | 301 |
Practice Address - City: | COLUMBUS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43213-1539 |
Practice Address - Country: | US |
Practice Address - Phone: | 614-234-7090 |
Practice Address - Fax: | 614-234-7901 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-09 |
Last Update Date: | 2017-10-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | Group - Multi-Specialty |