Provider Demographics
NPI:1417041336
Name:RECONSTRUCTIVE AND AESTHETIC SURGEONS, INC.
Entity Type:Organization
Organization Name:RECONSTRUCTIVE AND AESTHETIC SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:W
Authorized Official - Last Name:COLVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-534-6551
Mailing Address - Street 1:2865 N REYNOLDS RD
Mailing Address - Street 2:STE 250
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2068
Mailing Address - Country:US
Mailing Address - Phone:419-534-6551
Mailing Address - Fax:419-534-6563
Practice Address - Street 1:2865 N REYNOLDS RD
Practice Address - Street 2:STE 250
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2068
Practice Address - Country:US
Practice Address - Phone:419-534-6551
Practice Address - Fax:419-534-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE48132Medicare UPIN
OHD97995Medicare UPIN