Healthcare Provider Details

I. General information

NPI: 1306845078
Provider Name (Legal Business Name): SURGERY & GYNECOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W 3RD AVE STE R
COLUMBUS OH
43201-3256
US

IV. Provider business mailing address

PO BOX 931287
CLEVELAND OH
44193-0004
US

V. Phone/Fax

Practice location:
  • Phone: 614-294-1603
  • Fax: 614-294-4468
Mailing address:
  • Phone: 614-294-1603
  • Fax: 614-294-4468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: JUDY HUTTON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 614-294-1603