MEDICARE: COLUMBUS 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		IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000098215	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1588611198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	940 N MARR RD
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	IN
Zip	:	47201-2609
Country	:	US
Telephone Number	:	812-372-1370
Fax Number	:	812-373-9526

Provider Business Practice Location Address
First Line	:	940 N MARR RD
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	IN
Zip	:	47201-2609
Country	:	US
Telephone Number	:	812-372-1370
Fax Number	:	812-373-9526

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MARCY A ROSS
Credential	:	RN
Telephone Number	:	812-372-1370

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	04/09/2008

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