Provider Demographics
NPI:1497920144
Name:COLUMBIA SURGICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:COLUMBIA SURGICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-443-8773
Mailing Address - Street 1:1605 E BROADWAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8023
Mailing Address - Country:US
Mailing Address - Phone:573-443-8773
Mailing Address - Fax:573-443-6843
Practice Address - Street 1:2303 S HIGHWAY 65
Practice Address - Street 2:CSA MARSHALL CLINIC
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3734
Practice Address - Country:US
Practice Address - Phone:573-443-8773
Practice Address - Fax:573-443-6843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT540000Medicare PIN