Healthcare Provider Details

I. General information

NPI: 1992018790
Provider Name (Legal Business Name): REVISION ADVANCED SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 POLARIS PKWY
COLUMBUS OH
43240-6035
US

IV. Provider business mailing address

1080 POLARIS PKWY
COLUMBUS OH
43240-6035
US

V. Phone/Fax

Practice location:
  • Phone: 800-475-2113
  • Fax: 614-781-1974
Mailing address:
  • Phone: 800-475-2113
  • Fax: 614-781-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0642AS
License Number StateOH

VIII. Authorized Official

Name: DOUGLAS JAMES SCHUMER
Title or Position: PRESIDENT
Credential: MD
Phone: 419-525-3737