Provider Demographics
NPI:1437407269
Name:MCN HOSPITALIST GROUP LLC
Entity type:Organization
Organization Name:MCN HOSPITALIST GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-297-1158
Mailing Address - Street 1:100 W 3RD AVE
Mailing Address - Street 2:150
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3256
Mailing Address - Country:US
Mailing Address - Phone:614-297-1158
Mailing Address - Fax:614-299-3406
Practice Address - Street 1:2000 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1183
Practice Address - Country:US
Practice Address - Phone:740-522-7800
Practice Address - Fax:614-299-3406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX IDENTIFICATION NUMBER