Columbus Southern Medical Group LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OH34005855L Issued in OH

Legal business name

COLUMBUS SOUTHERN MEDICAL GROUP LLC

Practice address

2912 S High Street
Columbus, OH 43207

Phone

(614) 748-2000

Fax

(614) 748-3000

NPI assigned

Jun 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin Lake, DO

Title

Doctor

Phone

(614) 748-2000

Specialties & licenses 1

Addresses

Other names 1

• dr gursal LLC Former legal business name

Tax ID family

Columbus Southern Medical Group LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Columbus Southern Medical Group LLC

  • Clinic/Center
  • Columbus, OH
  • NPI 1174709422
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376579755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2912 S HIGH STREET",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "43207",
            "telephone_number": "614-748-2000",
            "fax_number": "614-748-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2912 S HIGH STREET",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "43207",
            "telephone_number": "614-748-2000",
            "fax_number": "614-748-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBUS SOUTHERN MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "614-748-2000",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "OH34005855L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dr gursal LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Columbus Southern Medical Group LLC
• Columbus Specialty Nursing LLC
• Columbus Speech and Hearing Center
• Columbus Speech and Hearing Center
• Columbus Spine and Sport Center, LLC
• Columbus Spine Specialists LLC

• All providers in Columbus, OH
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.