Provider Demographics
NPI:1982261947
Name:DERMATOLOGY CENTER OF COLUMBIA, LLC
Entity Type:Organization
Organization Name:DERMATOLOGY CENTER OF COLUMBIA, LLC
Other - Org Name:DERMATOLOGY CENTER OF COLUMBIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIAVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-673-2496
Mailing Address - Street 1:204 N KEENE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8136
Mailing Address - Country:US
Mailing Address - Phone:573-442-0320
Mailing Address - Fax:
Practice Address - Street 1:204 N KEENE ST STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8136
Practice Address - Country:US
Practice Address - Phone:573-442-0320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty