Provider Demographics
NPI:1194801969
Name:COLUMBUS HERNIA INSTITUTE
Entity type:Organization
Organization Name:COLUMBUS HERNIA INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:GRISCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-256-8766
Mailing Address - Street 1:5005 PARKCENTER AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3582
Mailing Address - Country:US
Mailing Address - Phone:614-256-8766
Mailing Address - Fax:614-898-5563
Practice Address - Street 1:5005 PARKCENTER AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3582
Practice Address - Country:US
Practice Address - Phone:614-256-8766
Practice Address - Fax:614-898-5563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007128174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2120770Medicaid