Provider Demographics
NPI:1871730580
Name:COLORECTAL SPECIALISTS LLC
Entity type:Organization
Organization Name:COLORECTAL SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-921-8686
Mailing Address - Street 1:4925 BRADENTON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7532
Mailing Address - Country:US
Mailing Address - Phone:614-921-8686
Mailing Address - Fax:614-921-8696
Practice Address - Street 1:4925 BRADENTON AVE STE C
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-7532
Practice Address - Country:US
Practice Address - Phone:614-921-8686
Practice Address - Fax:614-921-8696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009253208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2985757Medicaid
OH2985757Medicaid