Healthcare Provider Details

I. General information

NPI: 1033174081
Provider Name (Legal Business Name): COLUMBUS UROLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 KNIGHTSBRIDGE BLVD STE 110
COLUMBUS OH
43214-2463
US

IV. Provider business mailing address

PO BOX 634172 COLUMBUS UROLOGY INC
CINCINNATI OH
45263-4172
US

V. Phone/Fax

Practice location:
  • Phone: 614-273-0400
  • Fax: 614-273-0401
Mailing address:
  • Phone: 614-818-3576
  • Fax: 614-818-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES WILLIAM SIMON
Title or Position: SENIOR PARTNER
Credential: MD
Phone: 614-538-2222