1538167176 NPI number — SOUTHWEST OHIO AMBULATORY SURGERY CENTER, LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538167176 NPI number — SOUTHWEST OHIO AMBULATORY SURGERY CENTER, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST OHIO AMBULATORY SURGERY CENTER, LTD
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:
1538167176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
295 N BREIEL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45042-3807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-425-7327
Provider Business Mailing Address Fax Number:
513-425-0960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
295 N BREIEL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45042-3807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-425-0930
Provider Business Practice Location Address Fax Number:
513-425-0960
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NICOLAI
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
DIRECTOR OPERATIONS
Authorized Official Telephone Number:
513-425-7327

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  338 , 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: 200451270A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36001352 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2046057 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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