MEDICARE: DELPHOS AMBULATORY SURGERY CENTER INC

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	:	1215118930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELPHOS AMBULATORY SURGERY CENTER INC

Provider Business Mailing Address
First Line	:	1775 E FIFTH ST
Second Line	:	PO BOX 458
City	:	DELPHOS
State	:	OH
Zip	:	45833-0458
Country	:	US
Telephone Number	:	419-692-1055
Fax Number	:	419-692-4203

Provider Business Practice Location Address
First Line	:	1775 E FIFTH ST
Second Line	:
City	:	DELPHOS
State	:	OH
Zip	:	45833-0458
Country	:	US
Telephone Number	:	419-692-1055
Fax Number	:	419-692-4203

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CARL S WEHRI
Credential	:	MD
Telephone Number	:	419-692-1055

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	11/21/2007

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