Healthcare Provider Details

I. General information

NPI: 1679577167
Provider Name (Legal Business Name): WHITEHALL SURGERY CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/06/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 REFUGEE ROAD SUITE 160
PICKERINGTON OH
43147
US

IV. Provider business mailing address

1030 REFUGEE ROAD SUITE 160
PICKERINGTON OH
43147
US

V. Phone/Fax

Practice location:
  • Phone: 614-604-7444
  • Fax: 614-604-7445
Mailing address:
  • Phone: 614-604-7444
  • Fax: 614-604-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number07551C
License Number StateOH

VIII. Authorized Official

Name: MRS. LAURA SMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 614-604-7444