Provider Demographics
NPI: | 1568775005 |
---|---|
Name: | OHIO STATE UNIVERSITY MEDICAL CENTER |
Entity type: | Organization |
Organization Name: | OHIO STATE UNIVERSITY MEDICAL CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CLINICAL NURSE SPECIALIST |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | KATHLEEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CARROLL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN |
Authorized Official - Phone: | 614-293-5395 |
Mailing Address - Street 1: | 410 W 10TH AVE |
Mailing Address - Street 2: | 9 WR 996 |
Mailing Address - City: | COLUMBUS |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43210-1240 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 614-293-5395 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 410 W 10TH AVE |
Practice Address - Street 2: | 9 WR 996 |
Practice Address - City: | COLUMBUS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43210-1240 |
Practice Address - Country: | US |
Practice Address - Phone: | 614-293-5395 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-07-26 |
Last Update Date: | 2010-07-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | RN136532-COA1 | 282N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 282N00000X | Hospitals | General Acute Care Hospital |