Healthcare Provider Details

I. General information

NPI: 1063514107
Provider Name (Legal Business Name): OHIO SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 BETHEL RD
COLUMBUS OH
43214-1906
US

IV. Provider business mailing address

930 BETHEL RD
COLUMBUS OH
43214-1906
US

V. Phone/Fax

Practice location:
  • Phone: 614-451-0500
  • Fax: 614-451-2844
Mailing address:
  • Phone: 614-451-0500
  • Fax: 614-451-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number386
License Number StateOH

VIII. Authorized Official

Name: DR. MICHAEL D MARTYN
Title or Position: CHARIMAN OF THE BOARD
Credential: M.D.
Phone: 614-451-0500