Provider Demographics
NPI:1396780466
Name:CENTRAL OHIO UROLOGY GROUP, LLC
Entity type:Organization
Organization Name:CENTRAL OHIO UROLOGY GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIACOMELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:614-396-2635
Mailing Address - Street 1:701 TECH CENTER DRIVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230
Mailing Address - Country:US
Mailing Address - Phone:614-944-4806
Mailing Address - Fax:614-944-4750
Practice Address - Street 1:701 TECH CENTER DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230
Practice Address - Country:US
Practice Address - Phone:614-396-2684
Practice Address - Fax:614-396-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1083883391OtherDMERC
OH1144499237OtherDMERC
OH1518136605OtherDMERC
OH1811166986OtherDMERC
OH2660820Medicaid
OHDF0566OtherRAILROAD MEDICARE
OH1083883391OtherDMERC
OH1811166986OtherDMERC