Provider Demographics
NPI:1932286838
Name:COLUMBUS HOSPICE, INC.
Entity Type:Organization
Organization Name:COLUMBUS HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMAJD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-569-7992
Mailing Address - Street 1:7020 MOON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4900
Mailing Address - Country:US
Mailing Address - Phone:706-569-7992
Mailing Address - Fax:706-569-8560
Practice Address - Street 1:7020 MOON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-4900
Practice Address - Country:US
Practice Address - Phone:706-569-7992
Practice Address - Fax:706-569-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106-018-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA334649Medicaid
GAPIC1612EMedicaid
GA000370664AMedicaid
GA000370664AMedicaid