Healthcare Provider Details

I. General information

NPI: 1578745568
Provider Name (Legal Business Name): THE ENDOSCOPY CENTER OF WEST CENTRAL OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2793 SHAWNEE ROAD
LIMA OH
45806
US

IV. Provider business mailing address

2793 SHAWNEE RD
LIMA OH
45806-1444
US

V. Phone/Fax

Practice location:
  • Phone: 419-879-3636
  • Fax:
Mailing address:
  • Phone: 419-879-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1685871
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MARY VERHOFF
Title or Position: ADMINISTRATOR
Credential:
Phone: 419-879-3636