Healthcare Provider Details

I. General information

NPI: 1104214261
Provider Name (Legal Business Name): WEST CENTRAL SURGICAL CENTER-BAYSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2014
Last Update Date: 12/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 S COY RD
OREGON OH
43616-3452
US

IV. Provider business mailing address

7071 W CENTRAL AVE
TOLEDO OH
43617-2700
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-9459
  • Fax: 419-693-9429
Mailing address:
  • Phone: 419-843-1370
  • Fax: 419-843-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1086AS
License Number StateOH

VIII. Authorized Official

Name: WILLIAM G JAMES JR.
Title or Position: AUTHORIZED OFFICAL
Credential: MD
Phone: 419-843-1370