Healthcare Provider Details

I. General information

NPI: 1538528120
Provider Name (Legal Business Name): CENTRAL OHIO CLINICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S 3RD ST SUITE 200
COLUMBUS OH
43215-5134
US

IV. Provider business mailing address

175 S 3RD ST SUITE 200
COLUMBUS OH
43215-5134
US

V. Phone/Fax

Practice location:
  • Phone: 614-723-9336
  • Fax: 888-325-8724
Mailing address:
  • Phone: 614-723-9336
  • Fax: 888-325-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number35082025
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. CHRISTOPHER BROWN
Title or Position: MEMBER
Credential: MD
Phone: 614-493-8987