MEDICARE: COLUMBUS REGIONAL HEALTH PHYSICIANS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1124498605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS REGIONAL HEALTH PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	3875 W PRESIDENTIAL WAY
Second Line	:
City	:	EDINBURGH
State	:	IN
Zip	:	46124-9058
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2326 18TH ST
Second Line	:	SUITE 120
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5362
Country	:	US
Telephone Number	:	812-372-1570
Fax Number	:

Authorized Official
Title or Position	:	CMO
Name	:	DR. THOMAS A SONDERMAN
Credential	:	M.D.
Telephone Number	:	812-334-8958

Provider Enumeration Date	:	09/28/2015
Last Update Date	:	10/27/2015

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