Healthcare Provider Details

I. General information

NPI: 1780649269
Provider Name (Legal Business Name): MARIETTA SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 SECOND STREET
MARIETTA OH
45750
US

IV. Provider business mailing address

611 SECOND STREET
MARIETTA OH
45750
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-8596
  • Fax: 740-374-9087
Mailing address:
  • Phone: 740-374-8596
  • Fax: 740-374-9087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1081684
License Number StateOH

VIII. Authorized Official

Name: MRS. SHIRLEY A THOMAS
Title or Position: RN ADMINISTRATOR
Credential:
Phone: 740-374-8596