Provider Demographics
NPI:1972791200
Name:COLUMBIA COLON AND RECTAL SURGEONS
Entity type:Organization
Organization Name:COLUMBIA COLON AND RECTAL SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-779-0819
Mailing Address - Street 1:1415 BLANDING ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2922
Mailing Address - Country:US
Mailing Address - Phone:803-779-0819
Mailing Address - Fax:803-779-9476
Practice Address - Street 1:1415 BLANDING ST
Practice Address - Street 2:SUITE 2
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2922
Practice Address - Country:US
Practice Address - Phone:803-779-0819
Practice Address - Fax:803-779-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13344208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6907Medicare UPIN