MEDICARE: OSUMC JAMES CANCER HOSPTIAL

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	284300000X	Special Hospital	RN154329 NS07735	OH

General Provider Information

NPI Number	:	1619288099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSUMC JAMES CANCER HOSPTIAL

Provider Business Mailing Address
First Line	:	660 ACKERMAN RD FL 5
Second Line	:	PO BOX 183109
City	:	COLUMBUS
State	:	OH
Zip	:	43202-4500
Country	:	US
Telephone Number	:	614-293-5377
Fax Number	:	614-293-1490

Provider Business Practice Location Address
First Line	:	660 ACKERMAN RD FL 5
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-4500
Country	:	US
Telephone Number	:	614-293-5377
Fax Number	:	614-293-1490

Authorized Official
Title or Position	:	CNS
Name	:	LAUREL JEAN COURTNEY
Credential	:	RN
Telephone Number	:	614-293-5377

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	06/30/2010

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