Provider Demographics
NPI:1568450856
Name:MICHAEL J COONEY MD MARK D RICAURTE MD AND ASSOCIATES INC
Entity type:Organization
Organization Name:MICHAEL J COONEY MD MARK D RICAURTE MD AND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:COONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-228-3036
Mailing Address - Street 1:719 W TOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1510
Mailing Address - Country:US
Mailing Address - Phone:614-228-3036
Mailing Address - Fax:614-228-5040
Practice Address - Street 1:719 W TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1510
Practice Address - Country:US
Practice Address - Phone:614-228-3036
Practice Address - Fax:614-228-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0779555Medicaid
OH0226213Medicaid
NDRI0667061Medicare ID - Type UnspecifiedDR. MARK D. RICAURTE
OHA73845Medicare UPIN
OHE50030Medicare UPIN
OH0226213Medicaid