Provider Demographics
NPI:1447821665
Name:U.S. INSTITUTE FOR ADVANCED SINUS CARE AND RESEARCH, LLC
Entity type:Organization
Organization Name:U.S. INSTITUTE FOR ADVANCED SINUS CARE AND RESEARCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-867-3681
Mailing Address - Street 1:770 JASONWAY AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4360
Mailing Address - Country:US
Mailing Address - Phone:614-867-3681
Mailing Address - Fax:614-914-5025
Practice Address - Street 1:770 JASONWAY AVE STE 1B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4360
Practice Address - Country:US
Practice Address - Phone:614-867-3681
Practice Address - Fax:614-914-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2843874Medicaid