Provider Demographics
NPI:1871310292
Name:COLUMBUS CENTER FOR SPORTS AND REGENERATIVE MEDICINE
Entity type:Organization
Organization Name:COLUMBUS CENTER FOR SPORTS AND REGENERATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:FASIHUDDIN
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-636-2378
Mailing Address - Street 1:25 HIDDEN RAVINES DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9883
Mailing Address - Country:US
Mailing Address - Phone:614-636-2378
Mailing Address - Fax:
Practice Address - Street 1:25 HIDDEN RAVINES DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9883
Practice Address - Country:US
Practice Address - Phone:614-636-2378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty