Colonial City Internal Medicine, Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

80624 Issued in OH

Legal business name

COLONIAL CITY INTERNAL MEDICINE, INC.

Practice address

1661 Venture Dr
Suite a
Mount Vernon, OH 43050-8928

Phone

(740) 397-2915

Fax

(740) 397-3870

NPI assigned

Jul 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Frederocl Charles Carroll, M.D.

Title

President

Phone

(740) 397-2915

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396769980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1124",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430508124",
            "telephone_number": "740-397-2975",
            "fax_number": "740-397-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 VENTURE DR",
            "address_2": "SUITE A",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430508928",
            "telephone_number": "740-397-2915",
            "fax_number": "740-397-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL CITY INTERNAL MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "FREDEROCL",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "740-397-2915",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "80624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Mount Vernon, OH
• Providers in Mount Vernon, OH by specialty
• Internal 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.