MEDICARE: COLUMBUS NEIGHBORHOOD HEALTH CENTER INC.

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1588414973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS NEIGHBORHOOD HEALTH CENTER INC.

Provider Business Mailing Address
First Line	:	2780 AIRPORT DR STE 100
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2289
Country	:	US
Telephone Number	:	614-859-1906
Fax Number	:	614-645-5517

Provider Business Practice Location Address
First Line	:	946 PARSONS AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-2346
Country	:	US
Telephone Number	:	614-445-6275
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT SPECIALIST
Name	:	JOHNETTA RIDGEWAY
Credential	:
Telephone Number	:	614-859-1906

Provider Enumeration Date	:	03/26/2024
Last Update Date	:	05/09/2024

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