Organization
COLUMBUS PHYSICIAN RESOURCES INC
Active
Other names
Fourth and Diamond Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL RITENOUR D.O. (DO)
(419) 571-5290
Entity
Organization
Contact information
Practice address
380 CLINE AVE STE 1, MANSFIELD, OH 44907-1056
(419) 571-5290
(419) 522-0998
Mailing address
380 CLINE AVE STE 1, MANSFIELD, OH 44907-1056
(419) 571-5290
(419) 522-0998
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000122735
ANTHEM BCBS OF OH
OH
05
—
2075276
—
OH
Enumeration date
03/27/2007
Last updated
02/10/2020
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