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NPI Code Detail

MEDICARE: SARAH KOSTELECKY CPS

MEDICARE: SARAH KOSTELECKY CPS
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1932502911
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH KOSTELECKY CPS
Provider Business Mailing Address
First Line : PO BOX 5328
Second Line :
City : COLUMBUS
State : GA
Zip : 31906-0328
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1215 2ND AVE
Second Line :
City : COLUMBUS
State : GA
Zip : 31901-5244
Country : US
Telephone Number : 706-324-4061
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2014
Last Update Date : 10/03/2014

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Directions to “ SARAH KOSTELECKY CPS” Practice Location

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