MEDICARE: COLUMBUS UROLOGY 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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1922063072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS UROLOGY INC

Provider Business Mailing Address
First Line	:	PO BOX 634172
Second Line	:	COLUMBUS UROLOGY INC
City	:	CINCINNATI
State	:	OH
Zip	:	45263-4172
Country	:	US
Telephone Number	:	614-818-3576
Fax Number	:	614-818-0217

Provider Business Practice Location Address
First Line	:	477 COOPER RD
Second Line	:	STE 220
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-8053
Country	:	US
Telephone Number	:	614-818-0215
Fax Number	:	614-818-0217

Authorized Official
Title or Position	:	SENIOR PARTNER
Name	:	MR. JAMES WILLIAM SIMON
Credential	:	MD
Telephone Number	:	614-538-2222

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	01/15/2008

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