Healthcare Provider Details

I. General information

NPI: 1871310292
Provider Name (Legal Business Name): COLUMBUS CENTER FOR SPORTS AND REGENERATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HIDDEN RAVINES DR
POWELL OH
43065-9883
US

IV. Provider business mailing address

25 HIDDEN RAVINES DR
POWELL OH
43065-9883
US

V. Phone/Fax

Practice location:
  • Phone: 614-636-2378
  • Fax:
Mailing address:
  • Phone: 614-636-2378
  • Fax: 614-413-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AHMED FASIHUDDIN KHAN
Title or Position: OWNER
Credential: MD
Phone: 614-636-2378