Provider Demographics
NPI:1265508386
Name:BREAST CARE SPECIALISTS, INC.
Entity Type:Organization
Organization Name:BREAST CARE SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MUTERSPAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-865-9200
Mailing Address - Street 1:477 COOPER RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8053
Mailing Address - Country:US
Mailing Address - Phone:614-865-9200
Mailing Address - Fax:614-865-9800
Practice Address - Street 1:477 COOPER RD
Practice Address - Street 2:SUITE 310
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8053
Practice Address - Country:US
Practice Address - Phone:614-865-9200
Practice Address - Fax:614-865-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000306646OtherANTHEM PIN NUMBER
OH9338271Medicare PIN