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General NPI Number Information
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NPI Number | 1669468278
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Entity Type | Organization
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Legal Business Name | SULLIVAN PLASTIC AND RECONSTRUCTIVE SURGEY CENTER, INC
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7706 OLENTANGY RIVER RD
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City | COLUMBUS
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State | OH
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Zip | 43235-1317
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Country | US
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Telephone | 614-436-8888
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Fax | 614-436-8847
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Provider Business Mailing Address
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Address Line | 7706 OLENTANGY RIVER RD
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City | COLUMBUS
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State | OH
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Zip | 43235-1317
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Country | US
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Telephone | 614-436-8888
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Fax | 614-436-8847
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL SULLIVAN
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Credential | M.D.
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Telephone | 614-436-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 216 / ID 0317AS
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License Number State | OH
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