Provider Demographics
NPI:1821249467
Name:COLUMBUS MAMMOGRAPHY CENTER INC
Entity Type:Organization
Organization Name:COLUMBUS MAMMOGRAPHY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-459-7880
Mailing Address - Street 1:3600 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214
Mailing Address - Country:US
Mailing Address - Phone:614-459-7880
Mailing Address - Fax:614-459-3860
Practice Address - Street 1:3600 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 500
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214
Practice Address - Country:US
Practice Address - Phone:614-459-7880
Practice Address - Fax:614-459-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH107276261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9921551Medicare PIN