Provider Demographics
NPI:1265527857
Name:COLUMBUS NEUROLOGICAL GROUP INC
Entity type:Organization
Organization Name:COLUMBUS NEUROLOGICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-866-5555
Mailing Address - Street 1:5340 E MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2574
Mailing Address - Country:US
Mailing Address - Phone:614-866-5555
Mailing Address - Fax:614-866-1051
Practice Address - Street 1:5340 E MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2574
Practice Address - Country:US
Practice Address - Phone:614-866-5555
Practice Address - Fax:614-866-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0703591Medicaid
OHG50172Medicare UPIN
OHG62031Medicare UPIN
OHCO9225851Medicare ID - Type UnspecifiedBILLING NUMBER