MEDICARE: COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.

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	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	361025	OTHER	OH	CMS CERTIFICATION NUMBER (CCN) PART A
2	36D2050327	OTHER	OH	CLIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194071050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	2780 AIRPORT DR STE 100
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2289
Country	:	US
Telephone Number	:	614-645-5500
Fax Number	:	614-645-5517

Provider Business Practice Location Address
First Line	:	1751 ALUM CREEK DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207
Country	:	US
Telephone Number	:	614-526-5420
Fax Number	:	614-526-5421

Authorized Official
Title or Position	:	CEO
Name	:	CHARLETA B TAVARES
Credential	:
Telephone Number	:	614-859-1946

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	01/26/2024

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