Provider Demographics
NPI:1285794354
Name:CENTRAL OHIO CARDIOVASCULAR CONSULTANTS, INC
Entity type:Organization
Organization Name:CENTRAL OHIO CARDIOVASCULAR CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-486-2000
Mailing Address - Street 1:PO BOX 951512
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0017
Mailing Address - Country:US
Mailing Address - Phone:614-486-2000
Mailing Address - Fax:614-878-3873
Practice Address - Street 1:5131 BEACON HILL RD
Practice Address - Street 2:STE 120
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-4442
Practice Address - Country:US
Practice Address - Phone:614-486-2000
Practice Address - Fax:614-878-3873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2405632Medicaid
0898105Medicare PIN
0876572Medicare PIN
0876595Medicare PIN
0542936Medicare PIN
9920309Medicare ID - Type Unspecified
0876597Medicare PIN
0877936Medicare PIN
0542937Medicare PIN
0876594Medicare PIN
0877551Medicare PIN
0924195Medicare PIN
0924196Medicare PIN
0898106Medicare PIN
0924197Medicare PIN
OH2405632Medicaid
0876573Medicare PIN
0877937Medicare PIN
0552309Medicare PIN