Provider Demographics
NPI:1043614589
Name:SPS18, LLC
Entity Type:Organization
Organization Name:SPS18, LLC
Other - Org Name:SMITH FACIAL PLASTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEITZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-245-4263
Mailing Address - Street 1:725 BUCKLES CT N STE 210
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6884
Mailing Address - Country:US
Mailing Address - Phone:614-245-4263
Mailing Address - Fax:614-245-4269
Practice Address - Street 1:725 BUCKLES CT N STE 210
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6884
Practice Address - Country:US
Practice Address - Phone:614-245-4263
Practice Address - Fax:614-245-4269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081746207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4211991Medicare PIN
OHH80495Medicare UPIN