Provider Demographics
NPI:1457700684
Name:COLUMBUS INTEGRATIVE FAMILY MEDICINE CENTER LLC
Entity Type:Organization
Organization Name:COLUMBUS INTEGRATIVE FAMILY MEDICINE CENTER LLC
Other - Org Name:CIFMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KURPITA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-306-7140
Mailing Address - Street 1:453 WATERBURY CT
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5309
Mailing Address - Country:US
Mailing Address - Phone:614-515-5244
Mailing Address - Fax:614-515-5757
Practice Address - Street 1:453 WATERBURY CT
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5309
Practice Address - Country:US
Practice Address - Phone:614-515-5244
Practice Address - Fax:614-515-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350922171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty