Healthcare Provider Details

I. General information

NPI: 1558105759
Provider Name (Legal Business Name): COLUMBUS BUSINESS CHALLENGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 POWELL RD
POWELL OH
43065-9751
US

IV. Provider business mailing address

1660 POWELL RD
POWELL OH
43065-9751
US

V. Phone/Fax

Practice location:
  • Phone: 619-719-8455
  • Fax:
Mailing address:
  • Phone: 619-719-8455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: RICH M WAGNER
Title or Position: PRESIDENT
Credential:
Phone: 619-719-8455