Healthcare Provider Details

I. General information

NPI: 1922199496
Provider Name (Legal Business Name): SAMUEL CONSTANTINE COLACHIS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 KENNY RD
COLUMBUS OH
43221-3502
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-9211
  • Fax:
Mailing address:
  • Phone: 614-366-9211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35052282C
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number35052282C
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: