Basic Information
| Provider Information | |||||||||
| NPI: | 1487711503 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL OHIO SURGICAL GROUP, LLC | ||||||||
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| OtherOrganizationName: | COLUMBUS NEUROSURGICAL SPINE GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4995 BRADENTON AVE | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430173543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147345000 | ||||||||
| FaxNumber: | 6147345001 | ||||||||
| Practice Location | |||||||||
| Address1: | 4995 BRADENTON AVE | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430173543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147345000 | ||||||||
| FaxNumber: | 6147345001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 10/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | TROYER | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6147345000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.