Healthcare Provider Details

I. General information

NPI: 1932660438
Provider Name (Legal Business Name): DEDICATED COLUMBUS OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 MORSE RD
COLUMBUS OH
43229-5858
US

IV. Provider business mailing address

2260 MORSE RD
COLUMBUS OH
43229-5858
US

V. Phone/Fax

Practice location:
  • Phone: 614-702-7899
  • Fax: 305-393-5989
Mailing address:
  • Phone: 614-702-7899
  • Fax: 305-393-5989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MARY CHEN
Title or Position: OWNER
Credential:
Phone: 305-628-6117