1720179674 NPI number — COLUMBUS INSTITUTE OF PLASTIC SURGERY LTD

Table of content: (NPI 1720179674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720179674 NPI number — COLUMBUS INSTITUTE OF PLASTIC SURGERY LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBUS INSTITUTE OF PLASTIC SURGERY LTD
Provider Last Name:
Provider First Name:
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Provider Name Prefix Text:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1720179674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6499 E BROAD ST
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43213-6505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-322-2500
Provider Business Mailing Address Fax Number:
614-322-2532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6499 E BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43213-6505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-235-2326
Provider Business Practice Location Address Fax Number:
614-235-5194
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
BIVIK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-235-2326

Provider Taxonomy Codes

  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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