Provider Demographics
NPI:1427153469
Name:CENTRAL OHIO SKIN LASER CENTER INC
Entity type:Organization
Organization Name:CENTRAL OHIO SKIN LASER CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMIALEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-538-1200
Mailing Address - Street 1:4830 KNIGHTSBRIDGE BLVD
Mailing Address - Street 2:SUITE M
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2300
Mailing Address - Country:US
Mailing Address - Phone:614-538-1200
Mailing Address - Fax:614-538-0499
Practice Address - Street 1:4830 KNIGHTSBRIDGE BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2300
Practice Address - Country:US
Practice Address - Phone:614-538-1200
Practice Address - Fax:614-538-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0906461Medicaid
OHDA9768OtherRAILROAD MEDICARE
OHDA9768OtherRAILROAD MEDICARE