Provider Demographics
NPI:1710540976
Name:COLUMBUS MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:COLUMBUS MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BIDS & CONTRACTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-229-5116
Mailing Address - Street 1:500 E SWEDESFORD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1614
Mailing Address - Country:US
Mailing Address - Phone:800-229-5116
Mailing Address - Fax:
Practice Address - Street 1:5085 FAIRFIELD CT
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-1005
Practice Address - Country:US
Practice Address - Phone:800-229-5116
Practice Address - Fax:888-379-2524
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBUS MEDICAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0622478Medicaid
FL101287500Medicaid
IN201087800Medicaid
KY7100531280Medicaid
GA000979052Medicaid
IN300020711Medicaid
KY7100472200Medicaid