Provider Demographics
NPI:1861781858
Name:COLUMBIA MEDICAL, LLC
Entity type:Organization
Organization Name:COLUMBIA MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-337-7888
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:112 DELAWARE ROAD
Mailing Address - City:RIEGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18077-0112
Mailing Address - Country:US
Mailing Address - Phone:877-337-7888
Mailing Address - Fax:877-337-2637
Practice Address - Street 1:112 DELAWARE ROAD
Practice Address - Street 2:
Practice Address - City:RIEGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18077-0112
Practice Address - Country:US
Practice Address - Phone:877-337-7888
Practice Address - Fax:877-337-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies