Provider Demographics
NPI:1962596254
Name:COLUMBUS RADIOLOGY INC
Entity type:Organization
Organization Name:COLUMBUS RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:HASSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-379-4441
Mailing Address - Street 1:2400 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5360
Mailing Address - Country:US
Mailing Address - Phone:812-379-4441
Mailing Address - Fax:812-373-2114
Practice Address - Street 1:2400 E 17TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5360
Practice Address - Country:US
Practice Address - Phone:812-379-4441
Practice Address - Fax:812-373-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN052170Medicare ID - Type Unspecified