MEDICARE: COLUMBUS AESTHETIC AND PLASTIC SURGERY, INC

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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1699801555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS AESTHETIC AND PLASTIC SURGERY, INC

Provider Business Mailing Address
First Line	:	4971 ARLINGTON CENTRE BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2910
Country	:	US
Telephone Number	:	614-246-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	4971 ARLINGTON CENTRE BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2910
Country	:	US
Telephone Number	:	614-246-6900
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MR. PHILIP M TRIPOLI
Credential	:
Telephone Number	:	614-246-6900

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/22/2020

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