=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447378567
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLUMBUS PHYSICIAN RESOURCES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2007
-----------------------------------------------------
Last Update Date | 02/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 380 CLINE AVE STE 1
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44907-1056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-571-5290
-----------------------------------------------------
Fax | 419-522-0998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 380 CLINE AVE STE 1
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44907-1056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-571-5290
-----------------------------------------------------
Fax | 419-522-0998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DO
-----------------------------------------------------
Name | DR. PAUL RITENOUR
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 419-571-5290
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------