Columbia Medical Sport & Spine LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

D0051586 Issued in MD

Legal business name

COLUMBIA MEDICAL SPORT & SPINE LLC

Practice address

8600 Snowden River Pkwy
Suite 103
Columbia, MD 21045-1982

Phone

(410) 720-5555

Fax

(410) 381-4653

NPI assigned

Apr 16, 2013

Organization subpart

No

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

Authorized official

Name

Vaughan Dabbs

Title

Owner

Phone

(410) 599-6846

Specialties & licenses 3

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Victor Yonghoon Kim, M.D.

  • Family Medicine Physician
  • Ellicott City, MD
  • NPI 1629092465

  Single Specialty

  NPD (past)
• Lucia Ann Minvielle, NURSE PRACTITIONER

  • Adult Health Nurse Practitioner
  • Baltimore, MD
  • NPI 1760515134
  NPD (past)

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

{
    "created_epoch": "1366070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377561600000",
    "number": "1871936294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 SNOWDEN RIVER PKWY",
            "address_2": "SUITE 103",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210451982",
            "telephone_number": "410-720-5555",
            "fax_number": "410-381-4653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 SNOWDEN RIVER PKWY",
            "address_2": "SUITE 103",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210451982",
            "telephone_number": "410-720-5555",
            "fax_number": "410-381-4653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA MEDICAL SPORT & SPINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-16",
        "last_updated": "2013-08-27",
        "status": "A",
        "authorized_official_last_name": "DABBS",
        "authorized_official_first_name": "VAUGHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-599-6846"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "MD",
            "license": "D0051586",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Columbia Heritage Partners, LLC (Somerford Place-Columbia)
• Columbia Hickory Pharmacy Inc (Columbia Hickory Care Pharmacy)
• Columbia Joint Health LLC
• Columbia MD Orthopaedic ASC, LLC (Hickory Ridge Surgery Center)
• Columbia Med Services
• Columbia Medical Supply, LLC
• Columbia Mental Health Resources, Inc.
• Columbia Oral and Facial Surgery Center, LLC
• Columbia Outpatient Sedation LLC
• Columbia Parkway Surgery Center LLC

• General Practice Physician in Columbia, MD
• Providers in Columbia, MD by specialty
• General Practice Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; 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.