Provider Demographics
NPI:1881022275
Name:MOUNT CARMEL HEALTHPROVIDERS TWO, LLC
Entity Type:Organization
Organization Name:MOUNT CARMEL HEALTHPROVIDERS TWO, LLC
Other - Org Name:MOUNT CARMEL THORACIC EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-546-4621
Mailing Address - Street 1:5969 E BROAD ST
Mailing Address - Street 2:SUITE 409
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1546
Mailing Address - Country:US
Mailing Address - Phone:614-864-5864
Mailing Address - Fax:614-864-9302
Practice Address - Street 1:5969 E BROAD ST
Practice Address - Street 2:SUITE 409
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1546
Practice Address - Country:US
Practice Address - Phone:614-864-5864
Practice Address - Fax:614-864-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty