Healthcare Provider Details

I. General information

NPI: 1265624696
Provider Name (Legal Business Name): CENTRAL OHIO UROLOGY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 PLAZA PROPERTIES BOULEVARD SUITE 320
COLUMBUS OH
43219
US

IV. Provider business mailing address

3100 PLAZA PROPERTIES BLVD SUITE 310
COLUMBUS OH
43219-1531
US

V. Phone/Fax

Practice location:
  • Phone: 614-751-1010
  • Fax: 614-751-4692
Mailing address:
  • Phone: 614-944-4800
  • Fax: 614-944-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0843AS
License Number StateOH

VIII. Authorized Official

Name: MRS. LINDA M. MILLER
Title or Position: COO
Credential: M.B.A.
Phone: 614-944-4820