Provider Demographics
NPI:1679511182
Name:COLUMBUS VASCULAR MEDICINE INC
Entity Type:Organization
Organization Name:COLUMBUS VASCULAR MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAYBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-228-8272
Mailing Address - Street 1:285 E STATE ST
Mailing Address - Street 2:STE 460A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4354
Mailing Address - Country:US
Mailing Address - Phone:614-228-8272
Mailing Address - Fax:614-228-8271
Practice Address - Street 1:285 E STATE ST
Practice Address - Street 2:STE 460A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4354
Practice Address - Country:US
Practice Address - Phone:614-228-8272
Practice Address - Fax:614-228-8271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071159S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2824555Medicaid
OH9361601Medicare PIN