Provider Demographics
NPI:1518012244
Name:WEST CENTRAL OHIO AESTHETIC & RECONSTRUCTIVE SURGERY, INC.
Entity Type:Organization
Organization Name:WEST CENTRAL OHIO AESTHETIC & RECONSTRUCTIVE SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SLABY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-996-5645
Mailing Address - Street 1:PO BOX 748
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-0748
Mailing Address - Country:US
Mailing Address - Phone:419-996-5645
Mailing Address - Fax:419-996-5458
Practice Address - Street 1:1800 E 5TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-9139
Practice Address - Country:US
Practice Address - Phone:419-996-5645
Practice Address - Fax:419-996-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062878208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1518012244OtherANTHEM BCBS
OH22000000168747OtherANTHEM BCBS
OH000000168747OtherANTHEM BCBS
OH2061647Medicaid
OH=========OtherTAX ID NUMBER
OH1518012244OtherANTHEM BCBS