MEDICARE: WEST CENTRAL OHIO AESTHETIC & RECONSTRUCTIVE SURGERY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	35062878	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1518012244	OTHER	OH	ANTHEM BCBS
2	22000000168747	OTHER	OH	ANTHEM BCBS
3	000000168747	OTHER	OH	ANTHEM BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518012244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST CENTRAL OHIO AESTHETIC & RECONSTRUCTIVE SURGERY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 748
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45802-0748
Country	:	US
Telephone Number	:	419-996-5645
Fax Number	:	419-996-5458

Provider Business Practice Location Address
First Line	:	1800 E 5TH ST
Second Line	:	SUITE #2
City	:	DELPHOS
State	:	OH
Zip	:	45833-9139
Country	:	US
Telephone Number	:	419-996-5645
Fax Number	:	419-996-5458

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES ALAN SLABY
Credential	:	M.D.
Telephone Number	:	419-996-5645

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	04/20/2008

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Directions to “WEST CENTRAL OHIO AESTHETIC & RECONSTRUCTIVE SURGERY, INC. ” Practice Location

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