Organization
OSU PLASTIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY M. MOORE MD (DEPARTMENT CHAIR)
(614) 293-7656
Entity
Organization
Contact information
Practice address
915 OLENTANGY RIVER RD STE 2140, COLUMBUS, OH 43212-3153
(614) 293-8566
(614) 293-3381
Mailing address
700 ACKERMAN RD STE 2120, COLUMBUS, OH 43202-1559
(614) 293-8566
(614) 293-3381
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
—
—
208600000X
Surgery Physician
—
—
2086S0102X
Surgical Critical Care Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0053309
—
OH
01
—
DS4045
RAILROAD MEDICARE
OH
Enumeration date
05/18/2011
Last updated
03/04/2024
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