Healthcare Provider Details

I. General information

NPI: 1538122957
Provider Name (Legal Business Name): SURGERY CENTER OF CINCINNATI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 AICHOLTZ RD
CINCINNATI OH
45245-1506
US

IV. Provider business mailing address

4415 AICHOLTZ RD
CINCINNATI OH
45245-1506
US

V. Phone/Fax

Practice location:
  • Phone: 513-947-1130
  • Fax: 513-947-8541
Mailing address:
  • Phone: 513-947-1130
  • Fax: 513-947-8541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0587AS
License Number StateOH

VIII. Authorized Official

Name: VIRGIL RAY CANTRELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 513-947-1130