Provider Demographics
NPI:1457301574
Name:COLUMBIA SURGICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:COLUMBIA SURGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-443-8773
Mailing Address - Street 1:3220 BLUFF CREEK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3525
Mailing Address - Country:US
Mailing Address - Phone:573-443-8775
Mailing Address - Fax:573-443-6843
Practice Address - Street 1:3220 BLUFF CREEK DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3525
Practice Address - Country:US
Practice Address - Phone:573-443-8775
Practice Address - Fax:573-443-6843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500457700Medicaid
MO000013379Medicare PIN
MO5172570001Medicare NSC
MOCP9130Medicare PIN
MOT540000Medicare PIN
MO990001337Medicare PIN
MO500457700Medicaid