Provider Demographics
NPI:1023136587
Name:EDWARD L. COLBY D.O. INC.
Entity type:Organization
Organization Name:EDWARD L. COLBY D.O. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:COLBY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-432-3434
Mailing Address - Street 1:61353 SOUTHGATE RD
Mailing Address - Street 2:SUITE#6
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-6607
Mailing Address - Country:US
Mailing Address - Phone:740-432-3434
Mailing Address - Fax:740-432-4035
Practice Address - Street 1:61353 SOUTHGATE RD
Practice Address - Street 2:SUITE#6
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-6607
Practice Address - Country:US
Practice Address - Phone:740-432-3434
Practice Address - Fax:740-432-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000119977OtherCOMMUNITY MUTUAL
OH298728719002OtherMED MUTUAL ED
OH2341344Medicaid
OH0879830Medicaid
OH295500551002OtherMED MUTUAL LINDA
OH298728719002OtherMED MUTUAL ED
OH9327981Medicare ID - Type UnspecifiedPRACTICE ID
OH0717272Medicare ID - Type UnspecifiedCOLBY IND MEDICARE#
OHSWNP11221Medicare ID - Type UnspecifiedSWALLIE IND MEDICARE#