Provider Demographics
NPI:1699801555
Name:COLUMBUS AESTHETIC AND PLASTIC SURGERY, INC
Entity type:Organization
Organization Name:COLUMBUS AESTHETIC AND PLASTIC SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRIPOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-246-6900
Mailing Address - Street 1:4971 ARLINGTON CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2910
Mailing Address - Country:US
Mailing Address - Phone:614-246-6900
Mailing Address - Fax:
Practice Address - Street 1:4971 ARLINGTON CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2910
Practice Address - Country:US
Practice Address - Phone:614-246-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC09289331Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER