Provider Demographics
NPI:1487796207
Name:OHIO VASCULAR SURGERY INC
Entity type:Organization
Organization Name:OHIO VASCULAR SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-457-5191
Mailing Address - Street 1:941 CHATHAM LANE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2416
Mailing Address - Country:US
Mailing Address - Phone:614-457-5191
Mailing Address - Fax:614-459-6874
Practice Address - Street 1:941 CHATHAM LANE
Practice Address - Street 2:SUITE 215
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2416
Practice Address - Country:US
Practice Address - Phone:614-457-5191
Practice Address - Fax:614-459-6874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2005627Medicaid
OHCD5306OtherRR MEDICARE
OHLU0692482Medicare ID - Type Unspecified
OH9288921Medicare PIN