Provider Demographics
NPI:1316989551
Name:COLUMBUS COMMUNITY HEALTH REGIONAL SLEEP DISORDERS CENTER INC
Entity type:Organization
Organization Name:COLUMBUS COMMUNITY HEALTH REGIONAL SLEEP DISORDERS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-443-7800
Mailing Address - Street 1:100 W THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201
Mailing Address - Country:US
Mailing Address - Phone:614-443-7800
Mailing Address - Fax:614-299-3406
Practice Address - Street 1:1430 S HIGH STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1045
Practice Address - Country:US
Practice Address - Phone:614-443-7800
Practice Address - Fax:614-443-6960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHID01091Medicare PIN