Healthcare Provider Details

I. General information

NPI: 1255440129
Provider Name (Legal Business Name): GREATER COLUMBUS REGIONAL DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 E STATE ST SUITE 170
COLUMBUS OH
43215-4354
US

IV. Provider business mailing address

285 E STATE ST SUITE 170
COLUMBUS OH
43215
US

V. Phone/Fax

Practice location:
  • Phone: 614-228-9114
  • Fax: 614-228-9120
Mailing address:
  • Phone: 614-228-9114
  • Fax: 614-228-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN P MACLAURIN
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 614-460-6100