Healthcare Provider Details

I. General information

NPI: 1205869088
Provider Name (Legal Business Name): EAST COLUMBUS ORTHOPEDIC MEDICINE & PAIN CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MCNAUGHTEN RD SUITE 202
COLUMBUS OH
43213-2120
US

IV. Provider business mailing address

50 MCNAUGHTEN RD SUITE 202
COLUMBUS OH
43213-2120
US

V. Phone/Fax

Practice location:
  • Phone: 614-759-9761
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number34-003198
License Number StateOH

VIII. Authorized Official

Name: DR. RICHARD MARTIN
Title or Position: PRESIDENT/OWNER
Credential: D.O.
Phone: 614-759-9761