Provider Demographics
NPI:1750349635
Name:COLUMBUS AMBULATORY HEALTHCARE SERVICES, INC.
Entity type:Organization
Organization Name:COLUMBUS AMBULATORY HEALTHCARE SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:IRAHABEAULIENTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER-MUSZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:CMA, CPAR
Authorized Official - Phone:706-571-1823
Mailing Address - Street 1:1800 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3624
Mailing Address - Country:US
Mailing Address - Phone:706-571-1823
Mailing Address - Fax:706-660-6401
Practice Address - Street 1:700 CENTER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1546
Practice Address - Country:US
Practice Address - Phone:706-571-1011
Practice Address - Fax:706-320-8646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP45Medicare ID - Type UnspecifiedGROUP NUMBER