Healthcare Provider Details

I. General information

NPI: 1245309731
Provider Name (Legal Business Name): OHIO GASTROENTEOLOGY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MCNAUGHTEN RD STE 320
COLUMBUS OH
43213-2174
US

IV. Provider business mailing address

3400 OLENTANGY RIVER RD
COLUMBUS OH
43202-1523
US

V. Phone/Fax

Practice location:
  • Phone: 614-754-5500
  • Fax: 614-754-5501
Mailing address:
  • Phone: 614-754-5500
  • Fax: 614-457-9519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD A EDGIN
Title or Position: LAB DIRECTOR
Credential: MD
Phone: 614-754-5500