MEDICARE: WELLINGTON SPECIALTY 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

General Provider Information

NPI Number	:	1194341768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLINGTON SPECIALTY SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	4355 FERGUSON DR STE 190
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-5137
Country	:	US
Telephone Number	:	513-753-1940
Fax Number	:	513-752-0579

Provider Business Practice Location Address
First Line	:	4355 FERGUSON DR STE 190
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-5137
Country	:	US
Telephone Number	:	513-753-1940
Fax Number	:	513-752-0579

Authorized Official
Title or Position	:	NURSE ADMINISTRATOR
Name	:	FAITH HOWARD
Credential	:	RN, BSN
Telephone Number	:	513-735-1940

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	03/30/2021

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