Provider Demographics
NPI:1700892288
Name:COLUMBUS DIAGNOSTIC CENTER INC
Entity Type:Organization
Organization Name:COLUMBUS DIAGNOSTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-256-3460
Mailing Address - Street 1:PO BOX 931077
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-1077
Mailing Address - Country:US
Mailing Address - Phone:706-322-3000
Mailing Address - Fax:706-660-8044
Practice Address - Street 1:2040 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901
Practice Address - Country:US
Practice Address - Phone:706-322-3000
Practice Address - Fax:706-660-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00424823OtherRAILROAD MEDICARE
GAP00424826OtherRAILROAD MEDICARE PIN#
GAP00162534OtherRAILROAD MEDICARE
GAP00424825OtherRAILROAD MEDICARE PIN#
GAP00424820OtherRAILROAD MEDICARE PIN#
GACH0666OtherRAILROAD MEDICARE
GAP00424824OtherRAILROAD MEDICARE PIN#
GAP00424823OtherRAILROAD MEDICARE
GAP00424826OtherRAILROAD MEDICARE PIN#