MEDICARE: DCR SURGERY CENTER, LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center	0715AS	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174571970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DCR SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	245 W ELMWOOD DR STE 100
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-4259
Country	:	US
Telephone Number	:	937-938-6484
Fax Number	:	937-723-9837

Provider Business Practice Location Address
First Line	:	245 W ELMWOOD DR STE 100
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-4259
Country	:	US
Telephone Number	:	937-938-6484
Fax Number	:	937-723-9837

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABDUL SHAHID
Credential	:	M.D.
Telephone Number	:	937-938-6484

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	06/11/2026

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