Provider Demographics
NPI:1598198004
Name:PLASTIC SURGERY INSTITUTE OF OHIO, LLC
Entity Type:Organization
Organization Name:PLASTIC SURGERY INSTITUTE OF OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:C
Authorized Official - Last Name:STORCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:216-561-0133
Mailing Address - Street 1:28601 CHAGRIN BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4562
Mailing Address - Country:US
Mailing Address - Phone:216-561-0312
Mailing Address - Fax:516-561-0113
Practice Address - Street 1:28601 CHAGRIN BLVD STE 500
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4562
Practice Address - Country:US
Practice Address - Phone:216-561-0312
Practice Address - Fax:516-561-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0096001Medicaid
OHH057931Medicare PIN