Healthcare Provider Details

I. General information

NPI: 1548278567
Provider Name (Legal Business Name): LANCASTER SURGICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 DR. MIKE CLOUSE DR.
SOMERSET OH
43783
US

IV. Provider business mailing address

2405 N COLUMBUS ST SUITE 250
LANCASTER OH
43130-8185
US

V. Phone/Fax

Practice location:
  • Phone: 740-654-6213
  • Fax: 740-654-3346
Mailing address:
  • Phone: 740-654-6213
  • Fax: 740-654-3346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT O. JOHNSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 740-654-6213