MEDICARE: COLUMBUS FOOD SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335G00000X	Medical Foods Supplier

General Provider Information

NPI Number	:	1316621972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS FOOD SERVICE

Provider Business Mailing Address
First Line	:	4434 WESTERVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-6030
Country	:	US
Telephone Number	:	614-639-8373
Fax Number	:	614-639-8374

Provider Business Practice Location Address
First Line	:	4434 WESTERVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-6030
Country	:	US
Telephone Number	:	614-639-8373
Fax Number	:	614-639-8374

Authorized Official
Title or Position	:	MANAGER
Name	:	OMER MOHAMED
Credential	:
Telephone Number	:	614-639-8373

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “COLUMBUS FOOD SERVICE ” Practice Location

Language	Start Address	Practice Location

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