Healthcare Provider Details

I. General information

NPI: 1255330189
Provider Name (Legal Business Name): COLUMBUS OBSTETRICIANS - GYNECOLOGISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 RIDGE MILL DR
HILLIARD OH
43026-9231
US

IV. Provider business mailing address

750 MOUNT CARMEL MALL SUITE 100
COLUMBUS OH
43222-1553
US

V. Phone/Fax

Practice location:
  • Phone: 614-434-2400
  • Fax: 614-434-2499
Mailing address:
  • Phone: 614-434-2400
  • Fax: 614-434-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberCO9930607
License Number StateOH

VIII. Authorized Official

Name: MARK VANMETER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 614-434-2444