Organization
HOSPITAL SERVICES MEDICAL GROUP OF CLARK COUNTY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL W KOLODZIK MD (COO)
(800) 726-3627
Entity
Organization
Contact information
Practice address
2615 E HIGH ST, SPRINGFIELD, OH 45505-1412
(937) 325-0531
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4342
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1429529
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020406300
FBLP GRP PROVIDER NUMBER
OH
01
—
202763100
DOL GRP PROVIDER NUMBER
OH
01
—
203409
EEOICP GRP PROVIDER #
OH
05
—
2490844
—
OH
Enumeration date
09/13/2005
Last updated
09/04/2008
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