Provider Demographics
NPI:1912337239
Name:THE PLASTIC SURGERY CENTER
Entity type:Organization
Organization Name:THE PLASTIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BIVIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-322-2500
Mailing Address - Street 1:6499 E BROAD ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-6505
Mailing Address - Country:US
Mailing Address - Phone:614-322-2500
Mailing Address - Fax:614-322-2532
Practice Address - Street 1:6499 E BROAD ST
Practice Address - Street 2:SUITE 130
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-6505
Practice Address - Country:US
Practice Address - Phone:614-322-2500
Practice Address - Fax:614-322-2532
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COLUMBUS INSTITUTE OF PLASTIC SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0803AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical