Healthcare Provider Details

I. General information

NPI: 1699146365
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

3201 MIDDLE ROAD
COLUMBUS IN
47203-4427
US

IV. Provider business mailing address

3875 W PRESIDENTIAL WAY
EDINBURGH IN
46124-9058
US

V. Phone/Fax

Practice location:
  • Phone: 812-372-8281
  • Fax:
Mailing address:
  • Phone: 812-373-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine 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