Provider Demographics
NPI:1710214168
Name:MED COLUMBUS, LLC
Entity Type:Organization
Organization Name:MED COLUMBUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLEMENCY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-564-9067
Mailing Address - Street 1:1020 DENNISON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3497
Mailing Address - Country:US
Mailing Address - Phone:614-564-9067
Mailing Address - Fax:614-564-9167
Practice Address - Street 1:1020 DENNISON AVE
Practice Address - Street 2:SUITE #200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3497
Practice Address - Country:US
Practice Address - Phone:614-564-9067
Practice Address - Fax:614-564-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9386201Medicare PIN