1265624696 NPI number — CENTRAL OHIO UROLOGY SURGERY CENTER, LLC

Table of content: (NPI 1265624696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265624696 NPI number — CENTRAL OHIO UROLOGY SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL OHIO UROLOGY 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:
1265624696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 PLAZA PROPERTIES BLVD
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43219-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-944-4800
Provider Business Mailing Address Fax Number:
614-944-4750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 PLAZA PROPERTIES BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-751-1010
Provider Business Practice Location Address Fax Number:
614-751-4692
Provider Enumeration Date:
08/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
614-944-4820

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  0843AS , 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: 2863325 . This is a "MEDICARE ID NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 36C0001231 . This is a "MEDICARE CERTIFICATION NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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