Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E 5TH ST SUITE #2
DELPHOS OH
45833-9139
US

IV. Provider business mailing address

PO BOX 748
LIMA OH
45802-0748
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-5645
  • Fax: 419-996-5458
Mailing address:
  • Phone: 419-996-5645
  • Fax: 419-996-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35062878
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1518012244
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerANTHEM BCBS
# 2
Identifier22000000168747
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerANTHEM BCBS
# 3
Identifier000000168747
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerANTHEM BCBS
# 4
Identifier2061647
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: DR. JAMES ALAN SLABY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 419-996-5645