Healthcare Provider Details

I. General information

NPI: 1174994834
Provider Name (Legal Business Name): COLUMBUS REGIONAL HEALTH PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 18TH ST SUITE 210
COLUMBUS IN
47201-5362
US

IV. Provider business mailing address

3875 W PRESIDENTIAL WAY
EDINBURGH IN
46124-9058
US

V. Phone/Fax

Practice location:
  • Phone: 812-372-8426
  • Fax:
Mailing address:
  • Phone: 812-373-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS A SONDERMAN
Title or Position: CMO
Credential: M.D.
Phone: 812-334-8958