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General NPI Number Information
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NPI Number | 1548338635
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Entity Type | Organization
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Legal Business Name | COLUMBUS URGENT CARE CENTER
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 2502 25TH ST
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City | COLUMBUS
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State | IN
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Zip | 47201-3728
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Country | US
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Telephone | 812-372-8883
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Fax | 812-372-8964
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Provider Business Mailing Address
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Address Line | 2502 25TH ST
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City | COLUMBUS
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State | IN
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Zip | 47201-3728
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Country | US
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Telephone | 812-372-8883
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Fax | 812-372-8964
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Authorized Official
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Title or Position | BOARD OF DIRECTORS
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Name | MR. KURT ELLIS
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Credential |
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Telephone | 812-376-5015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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