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General NPI Number Information
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NPI Number | 1538531215
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Entity Type | Organization
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Legal Business Name | COLUMBIA HEALTH CARE, LLC
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 7120 MINSTREL WAY SUITE 105B
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City | COLUMBIA
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State | MD
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Zip | 21045-5248
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Country | US
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Telephone | 410-290-3903
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Fax | 410-290-3905
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Provider Business Mailing Address
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Address Line | 7120 MINSTREL WAY SUITE 105B
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City | COLUMBIA
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State | MD
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Zip | 21045-5248
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Country | US
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Telephone | 410-290-3903
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Fax | 410-290-3905
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DANIEL Y PEFOK
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Credential |
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Telephone | 410-848-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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