Healthcare Provider Details

I. General information

NPI: 1336323393
Provider Name (Legal Business Name): UROGYNECOLOGY & PELVIC FLOOR SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 04/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W STATE ST SUITE 550A
COLUMBUS OH
43222-1515
US

IV. Provider business mailing address

745 W STATE ST SUITE 550A
COLUMBUS OH
43222-1515
US

V. Phone/Fax

Practice location:
  • Phone: 614-224-7662
  • Fax: 614-224-7682
Mailing address:
  • Phone: 614-224-7662
  • Fax: 614-224-7682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35065038
License Number StateOH

VIII. Authorized Official

Name: RENEE CAPUTO
Title or Position: OWNER
Credential: M.D.
Phone: 614-224-7662