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General NPI Number Information
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NPI Number | 1710214168
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Entity Type | Organization
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Legal Business Name | MED COLUMBUS, LLC
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Dates
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Enumeration Date | 11/05/2009
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 1020 DENNISON AVE SUITE #200
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City | COLUMBUS
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State | OH
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Zip | 43201-3497
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Country | US
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Telephone | 614-564-9067
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Fax | 614-564-9167
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Provider Business Mailing Address
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Address Line | 1020 DENNISON AVE SUITE 200
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City | COLUMBUS
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State | OH
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Zip | 43201-3497
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Country | US
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Telephone | 614-564-9067
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Fax | 614-564-9167
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAREN A CLEMENCY
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Credential | M.D.
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Telephone | 614-564-9067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35053771
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License Number State | OH
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