Provider Demographics
NPI:1750820908
Name:COLUMBUS MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:COLUMBUS MEDICAL SERVICES, LLC
Other - Org Name:THE COLUMBUS ORGANIZATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. PROJECT 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
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5550 W EXECUTIVE DR STE 230
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1046
Practice Address - Country:US
Practice Address - Phone:800-229-5116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000979052FMedicaid
GA000979052JMedicaid
GA000979052KMedicaid
TN1512668Medicaid
GA000979052DMedicaid
GA000979052HMedicaid
GA000979052IMedicaid
IN201212480AMedicaid
IN201087800AMedicaid
GA000979052GMedicaid
GA000979052EMedicaid