Provider Demographics
NPI:1902856933
Name:COLUMBUS CLINICAL SVC LLC
Entity Type:Organization
Organization Name:COLUMBUS CLINICAL SVC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:CANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-559-5759
Mailing Address - Street 1:15 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1415
Mailing Address - Country:US
Mailing Address - Phone:305-559-5759
Mailing Address - Fax:305-559-5772
Practice Address - Street 1:15 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1415
Practice Address - Country:US
Practice Address - Phone:305-559-5759
Practice Address - Fax:305-559-5772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty