Healthcare Provider Details

I. General information

NPI: 1962489393
Provider Name (Legal Business Name): SURGICENTER GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W GARDNER DR
MARION IN
46952-1821
US

IV. Provider business mailing address

PO BOX 472
MUNCIE IN
47308-0472
US

V. Phone/Fax

Practice location:
  • Phone: 765-664-2000
  • Fax: 765-668-6797
Mailing address:
  • Phone: 765-286-8888
  • Fax: 765-747-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number005975
License Number StateIN

VIII. Authorized Official

Name: DR. KEVIN T SCRIPTURE
Title or Position: PART OWNER
Credential: M.D.
Phone: 765-966-1945