Healthcare Provider Details

I. General information

NPI: 1467982579
Provider Name (Legal Business Name): MED CLINIC OF COLUMBUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E MAIN ST STE 105A
COLUMBUS OH
43215-5369
US

IV. Provider business mailing address

5821 SOUTHWEST FWY STE 550
HOUSTON TX
77057-7531
US

V. Phone/Fax

Practice location:
  • Phone: 614-962-6330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EMMA CULL
Title or Position: COO
Credential:
Phone: 678-469-5011