Provider Demographics
NPI:1104976299
Name:CENTRAL OHIO COLON AND RECTAL CTR, INC.
Entity type:Organization
Organization Name:CENTRAL OHIO COLON AND RECTAL CTR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHITT
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:614-864-1000
Mailing Address - Street 1:5965 EAST BROAD STREET
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213
Mailing Address - Country:US
Mailing Address - Phone:614-864-1000
Mailing Address - Fax:614-864-1444
Practice Address - Street 1:5965 E BROAD ST
Practice Address - Street 2:SUITE 120
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1562
Practice Address - Country:US
Practice Address - Phone:614-864-1000
Practice Address - Fax:614-864-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0374929Medicaid
OH2313428Medicaid
OH2327897Medicaid
OH2313419Medicaid
OH9161334Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
OH2327897Medicaid
OH9161333Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
OH2313419Medicaid
OH0374929Medicaid