Provider Demographics
NPI:1194965699
Name:CENTRAL OHIO PEDIATRIC ENDOCRINOLOGY & DIABETES SERV LLC
Entity type:Organization
Organization Name:CENTRAL OHIO PEDIATRIC ENDOCRINOLOGY & DIABETES SERV LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:ZIPF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-839-3040
Mailing Address - Street 1:55 DILLMONT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-6458
Mailing Address - Country:US
Mailing Address - Phone:614-839-3040
Mailing Address - Fax:614-839-3041
Practice Address - Street 1:55 DILLMONT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-6458
Practice Address - Country:US
Practice Address - Phone:614-839-3040
Practice Address - Fax:614-839-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHZ10493253OtherMEDICARE INDIVIDUAL
A79972OtherUPIN
OH0373760Medicaid
OH2044488Medicaid
OHCE9314531OtherMEDICARE GROUP
E21314OtherUPIN