1285664300 NPI number — PHYSICIANS OUTPATIENT SURGERY CENTER, LLC

Table of content: (NPI 1285664300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285664300 NPI number — PHYSICIANS OUTPATIENT SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS OUTPATIENT SURGERY 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:
Provider Other Organization Name Type Code:
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:
1285664300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
418 GRAND PARK DR
Provider Second Line Business Mailing Address:
SUITE 315
Provider Business Mailing Address City Name:
PARKERSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26105-4000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-428-3500
Provider Business Mailing Address Fax Number:
304-422-7900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1933 WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELPRE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45714-2041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-423-7557
Provider Business Practice Location Address Fax Number:
740-423-7559
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GEORGE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
SPENCER
Authorized Official Title or Position:
PARTNER/MEDICAL DIRECTOR
Authorized Official Telephone Number:
304-428-3500

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 119897 . This is a "CARELINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 490004533 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: ASC49113 . This is a "THE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000190429 . This is a "ANTHEM BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2258471 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000328563 . This is a "MOUNTAIN STATE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6904001000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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