Provider Demographics
NPI:1104991371
Name:CONSOLIDATED MEDICAL SPECIALISTS, INC.
Entity type:Organization
Organization Name:CONSOLIDATED MEDICAL SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EMLICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO, FACOI
Authorized Official - Phone:614-870-1234
Mailing Address - Street 1:PO BOX 12626
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-0626
Mailing Address - Country:US
Mailing Address - Phone:614-870-1234
Mailing Address - Fax:614-870-3199
Practice Address - Street 1:4930 W BROAD ST STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1696
Practice Address - Country:US
Practice Address - Phone:614-870-1234
Practice Address - Fax:614-870-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004432207R00000X, 207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9266712Medicare PIN
OH9266711Medicare PIN