Provider Demographics
NPI:1720062805
Name:CENTRAL OHIO PULMONARY DISEASE INC
Entity type:Organization
Organization Name:CENTRAL OHIO PULMONARY DISEASE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-464-0788
Mailing Address - Street 1:745 WEST STATE ST
Mailing Address - Street 2:STE 510
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1515
Mailing Address - Country:US
Mailing Address - Phone:614-464-0788
Mailing Address - Fax:614-464-0295
Practice Address - Street 1:745 WEST STATE ST
Practice Address - Street 2:STE 510
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1515
Practice Address - Country:US
Practice Address - Phone:614-464-0788
Practice Address - Fax:614-464-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0424857Medicaid
OH0424857Medicaid