Provider Demographics
NPI:1588038236
Name:AESTHETIC RECONSTRUCTIVE TATTOOS OF OHIO
Entity Type:Organization
Organization Name:AESTHETIC RECONSTRUCTIVE TATTOOS OF OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLINDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, FNP-BC
Authorized Official - Phone:740-357-4503
Mailing Address - Street 1:1834 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-9310
Mailing Address - Country:US
Mailing Address - Phone:740-244-8266
Mailing Address - Fax:
Practice Address - Street 1:1834 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2934
Practice Address - Country:US
Practice Address - Phone:740-244-8266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 14765-NP261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0089230Medicaid