Provider Demographics
NPI:1194760439
Name:CITY OF COLUMBUS
Entity type:Organization
Organization Name:CITY OF COLUMBUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:614-645-7417
Mailing Address - Street 1:240 PARSONS AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5331
Mailing Address - Country:US
Mailing Address - Phone:614-645-6793
Mailing Address - Fax:614-645-6091
Practice Address - Street 1:240 PARSONS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5331
Practice Address - Country:US
Practice Address - Phone:614-645-6792
Practice Address - Fax:614-645-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0115011Medicaid
OH0115011Medicaid
OH0115011Medicaid