Provider Demographics
NPI:1669553558
Name:COLUMBUS SURGICAL SPECIALISTS INC
Entity type:Organization
Organization Name:COLUMBUS SURGICAL SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-263-1865
Mailing Address - Street 1:3555 OLENTANGY RIVER RD
Mailing Address - Street 2:STE 2000
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3912
Mailing Address - Country:US
Mailing Address - Phone:614-263-1865
Mailing Address - Fax:614-263-5998
Practice Address - Street 1:3555 OLENTANGY RIVER RD
Practice Address - Street 2:STE 2000
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3912
Practice Address - Country:US
Practice Address - Phone:614-263-1865
Practice Address - Fax:614-263-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0247807Medicaid
OH9285711Medicare PIN