Provider Demographics
NPI:1841585072
Name:SOUTHERN OHIO PLASTIC & RECONSTRUCTIVE SURGICAL INSTITUTE
Entity Type:Organization
Organization Name:SOUTHERN OHIO PLASTIC & RECONSTRUCTIVE SURGICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINDSAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-283-2510
Mailing Address - Street 1:630 W MAIN ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2170
Mailing Address - Country:US
Mailing Address - Phone:937-283-2510
Mailing Address - Fax:937-283-2513
Practice Address - Street 1:630 W MAIN ST
Practice Address - Street 2:SUITE 304
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2170
Practice Address - Country:US
Practice Address - Phone:937-283-2510
Practice Address - Fax:937-283-2513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010298208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty