Provider Demographics
NPI:1346290566
Name:COLUMBUS PHYSICIANS ASSOCIATES PC
Entity type:Organization
Organization Name:COLUMBUS PHYSICIANS ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:THEODORA
Authorized Official - Middle Name:
Authorized Official - Last Name:SADDORIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-376-7824
Mailing Address - Street 1:2753 FOXPOINTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3224
Mailing Address - Country:US
Mailing Address - Phone:812-376-7824
Mailing Address - Fax:812-378-8390
Practice Address - Street 1:2753 FOXPOINTE DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3224
Practice Address - Country:US
Practice Address - Phone:812-376-7824
Practice Address - Fax:812-378-8390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN054210Medicare PIN