Healthcare Provider Details

I. General information

NPI: 1518095520
Provider Name (Legal Business Name): COLUMBUS PULMONARY AND CRITICAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W STATE ST SUITE 610
COLUMBUS OH
43222
US

IV. Provider business mailing address

745 W STATE ST SUITE 610
COLUMBUS OH
43222
US

V. Phone/Fax

Practice location:
  • Phone: 614-224-0093
  • Fax: 614-221-5480
Mailing address:
  • Phone: 614-224-0093
  • Fax: 614-221-5480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35054825
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35054825
License Number StateOH

VIII. Authorized Official

Name: DR. ROY C ST JOHN
Title or Position: PRESIDENT
Credential: MD
Phone: 614-224-0093