1093710873 NPI number — DUBLIN SURGICAL CENTER, LLC

Table of content: (NPI 1093710873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093710873 NPI number — DUBLIN SURGICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUBLIN SURGICAL CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COLUMBUS SURGICAL CENTER
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093710873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5005 PARKCENTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43017-3582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-932-9548
Provider Business Mailing Address Fax Number:
614-932-9549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5005 PARKCENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43017-3582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-932-9548
Provider Business Practice Location Address Fax Number:
614-932-9549
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PURR
Authorized Official First Name:
TERI
Authorized Official Middle Name:
Authorized Official Title or Position:
FACILITY ADMINISTRATOR
Authorized Official Telephone Number:
614-932-9548

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  0731AS , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000317382 . This is a "ANTHEM ASC PROVIDER NUMBE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00119531 . This is a "MEDICARE RAILROAD ASC" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 2474719 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 311256934004 . This is a "TRICARE FOR LIFE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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