Provider Demographics
NPI:1053605519
Name:GALEN H. DAVIS, M.D.
Entity type:Organization
Organization Name:GALEN H. DAVIS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:GALEN
Authorized Official - Middle Name:HUBERT
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-501-1600
Mailing Address - Street 1:5320 E MAIN ST
Mailing Address - Street 2:STE 800
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2506
Mailing Address - Country:US
Mailing Address - Phone:614-501-1600
Mailing Address - Fax:614-501-8510
Practice Address - Street 1:5320 E MAIN ST
Practice Address - Street 2:STE 800
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2506
Practice Address - Country:US
Practice Address - Phone:614-501-1600
Practice Address - Fax:614-501-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3522760302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2020637Medicaid
OH2020637Medicaid