MEDICARE: TAYLOR STATION SURGICAL CENTER LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1043067036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAYLOR STATION SURGICAL CENTER LTD

Provider Business Mailing Address
First Line	:	275 TAYLOR STATION RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2927
Country	:	US
Telephone Number	:	614-751-4466
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 TAYLOR STATION RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2927
Country	:	US
Telephone Number	:	614-751-4466
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL DIRECTOR OF REIMBURSEMENT
Name	:	TERRANCE SLAVIN
Credential	:
Telephone Number	:	734-343-3320

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	05/07/2024

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