Basic Information
| Provider Information | |||||||||
| NPI: | 1841395639 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OSU ELECTROPHYSIOLOGY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 ACKERMAN ROAD | ||||||||
| Address2: | PO BOX 183103 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432183103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142932391 | ||||||||
| FaxNumber: | 6142936479 | ||||||||
| Practice Location | |||||||||
| Address1: | 452 W. 10TH AVE | ||||||||
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| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142937677 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 06/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | STONE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO/ADMINISTRATOR OSU HEALTH SYSTEM | ||||||||
| AuthorizedOfficialTelephone: | 6142032150 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 2682959 | 05 | OH | MEDICAID |