Healthcare Provider Details

I. General information

NPI: 1780684043
Provider Name (Legal Business Name): TUSCARAWAS AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 OXFORD ST
DOVER OH
44622-1963
US

IV. Provider business mailing address

320 OXFORD ST
DOVER OH
44622-1963
US

V. Phone/Fax

Practice location:
  • Phone: 330-365-2101
  • Fax:
Mailing address:
  • Phone: 330-365-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0560AS
License Number StateOH

VIII. Authorized Official

Name: MR. TIM LONGVILLE
Title or Position: CHIEF ACCOUNTING OFFICER AND CONTRO
Credential:
Phone: 216-636-7416