Provider Demographics
NPI:1205889987
Name:COLUMBUS ORTHOPEDIC & SPORTS MEDICINE CLINIC P C
Entity type:Organization
Organization Name:COLUMBUS ORTHOPEDIC & SPORTS MEDICINE CLINIC P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:CIMPL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-563-3644
Mailing Address - Street 1:4508 38TH STREET
Mailing Address - Street 2:SUITE 133
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1668
Mailing Address - Country:US
Mailing Address - Phone:402-563-3644
Mailing Address - Fax:402-564-5805
Practice Address - Street 1:4508 38TH STREET
Practice Address - Street 2:SUITE 133
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601
Practice Address - Country:US
Practice Address - Phone:402-563-3644
Practice Address - Fax:402-564-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE99207Medicare UPIN
NE0247650001Medicare NSC