Provider Demographics
NPI:1053591966
Name:COLUMBUS RADIATION ONCOLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:COLUMBUS RADIATION ONCOLOGY ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-660-8121
Mailing Address - Street 1:2121 WARM SPRINGS RD STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-7954
Mailing Address - Country:US
Mailing Address - Phone:706-660-8121
Mailing Address - Fax:706-323-4205
Practice Address - Street 1:2121 WARM SPRINGS RD STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-7954
Practice Address - Country:US
Practice Address - Phone:706-660-8121
Practice Address - Fax:706-323-4205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18964261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3353OtherMEDICARE
GA30BDCTPMedicare UPIN