Southern Indiana Aesthetic and Plastic Surgery LLC

Primary specialty

Surgical TechnologistTaxonomy code 246ZS0410X

License

01046379A Issued in IN

Legal business name

SOUTHERN INDIANA AESTHETIC AND PLASTIC SURGERY LLC

Practice address

2450 N Park Dr Ste B
Columbus, IN 47203-2292

Phone

(812) 376-8997

Fax

(812) 373-5323

NPI assigned

Aug 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Thomas Logan Jackson, M.D.NPI 1154308997

Title

Owner

Phone

(812) 376-8997

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas L Jackson, M.D.

  • Specialist
  • Columbus, IN
  • NPI 1154308997

  IN

  Medicare reassignment Care Compare group Authorized official
• Jacob Nathaniel Grow

  • Plastic Surgery Physician
  • Cleveland, OH
  • NPI 1487071650

  IN

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354579200000",
    "number": "1487765103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 N PARK DR STE B",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472032292",
            "telephone_number": "812-376-8997",
            "fax_number": "812-373-5323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 N PARK DR STE B",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472032292",
            "telephone_number": "812-376-8997",
            "fax_number": "812-373-5323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN INDIANA AESTHETIC AND PLASTIC SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-12-04",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "LOGAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-376-8997",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "IN",
            "license": "01046379A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Columbus, IN
• Surgical Technologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.