MEDICARE: NEW ALBANY JAW AND FACIAL SURGERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	20162	OH

General Provider Information

NPI Number	:	1013266295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW ALBANY JAW AND FACIAL SURGERY

Provider Business Mailing Address
First Line	:	1575 CROSS CREEKS BLVD
Second Line	:
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-8237
Country	:	US
Telephone Number	:	614-751-7500
Fax Number	:	614-322-7900

Provider Business Practice Location Address
First Line	:	5101 FOREST DR
Second Line	:	SUITE B
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-8215
Country	:	US
Telephone Number	:	614-751-7500
Fax Number	:	614-322-7900

Authorized Official
Title or Position	:	BILLING OFFICE COORDINATOR
Name	:	AMY R COLLINS
Credential	:
Telephone Number	:	614-751-7500

Provider Enumeration Date	:	09/04/2012
Last Update Date	:	09/04/2012

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