Healthcare Provider Details

I. General information

NPI: 1497920144
Provider Name (Legal Business Name): COLUMBIA SURGICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 S HIGHWAY 65 CSA MARSHALL CLINIC
MARSHALL MO
65340-3734
US

IV. Provider business mailing address

1605 E BROADWAY SUITE 110
COLUMBIA MO
65201-8023
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-8773
  • Fax: 573-443-6843
Mailing address:
  • Phone: 573-443-8773
  • Fax: 573-443-6843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SHARON K SMITH
Title or Position: PRACTICE MANAGER
Credential:
Phone: 573-443-8773