Provider Demographics
NPI:1396715025
Name:SANDUSKY PLASTIC SURGERY INC
Entity type:Organization
Organization Name:SANDUSKY PLASTIC SURGERY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PARSCHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-626-2800
Mailing Address - Street 1:2616 HAYES AVE
Mailing Address - Street 2:SANDUSKY PLASTIC SURGERY INC
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870
Mailing Address - Country:US
Mailing Address - Phone:419-626-2800
Mailing Address - Fax:419-626-2820
Practice Address - Street 1:2616 HAYES AVE
Practice Address - Street 2:SANDUSKY PLASTIC SURGERY INC
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870
Practice Address - Country:US
Practice Address - Phone:419-626-2800
Practice Address - Fax:419-626-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2071252Medicaid
OH000000248840OtherANTHEM
OH2071252Medicaid
OHCG9257Medicare ID - Type UnspecifiedRAILROAD NUMBER
OH=========004OtherMEDICAL MUTUAL