Healthcare Provider Details

I. General information

NPI: 1982696894
Provider Name (Legal Business Name): AFFILIATED AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SHAWAN FALLS DR
DUBLIN OH
43017-2100
US

IV. Provider business mailing address

650 SHAWAN FALLS DR
DUBLIN OH
43017-2100
US

V. Phone/Fax

Practice location:
  • Phone: 614-764-1711
  • Fax: 614-889-2652
Mailing address:
  • Phone: 614-764-1711
  • Fax: 614-889-2652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0059AS
License Number StateOH

VIII. Authorized Official

Name: DR. DWIGHT A SCARBOROUGH
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 614-764-1711