Provider Demographics
NPI:1083889752
Name:CENTRAL OHIO UROLOGY GROUP, LLC
Entity type:Organization
Organization Name:CENTRAL OHIO UROLOGY GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIACOMELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-396-2635
Mailing Address - Street 1:620 MORRISON RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5327
Mailing Address - Country:US
Mailing Address - Phone:614-944-4770
Mailing Address - Fax:614-944-4771
Practice Address - Street 1:620 MORRISON RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5327
Practice Address - Country:US
Practice Address - Phone:614-944-4770
Practice Address - Fax:614-944-4771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty