Provider Demographics
NPI:1932263621
Name:COLUMBIA OCALA REGIONAL MEDICAL CENTER PHYSICIAN GROUP INC
Entity Type:Organization
Organization Name:COLUMBIA OCALA REGIONAL MEDICAL CENTER PHYSICIAN GROUP INC
Other - Org Name:OAK HILL PHYSICIAN GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANNESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-793-6004
Mailing Address - Street 1:700 SE 5TH TER
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4878
Mailing Address - Country:US
Mailing Address - Phone:352-795-8815
Mailing Address - Fax:352-564-1090
Practice Address - Street 1:700 SE 5TH TER
Practice Address - Street 2:SUITE 5
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4878
Practice Address - Country:US
Practice Address - Phone:352-795-8815
Practice Address - Fax:352-564-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00646524OtherRAILROAD MEDICARE
K0106Medicare PIN