Healthcare Provider Details

I. General information

NPI: 1508935370
Provider Name (Legal Business Name): COLUMBUS CARDIOLOGY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 18TH ST SUITE 130
COLUMBUS IN
47201-5387
US

IV. Provider business mailing address

2325 18TH ST SUITE 130
COLUMBUS IN
47201-5387
US

V. Phone/Fax

Practice location:
  • Phone: 812-379-2020
  • Fax: 812-378-8267
Mailing address:
  • Phone: 812-379-2020
  • Fax: 812-378-8267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number50003293A
License Number StateIN

VIII. Authorized Official

Name: KEVIN CHRISTOPHER PREUSS
Title or Position: SECRETARY
Credential: M.D.
Phone: 812-379-2020