Healthcare Provider Details

I. General information

NPI: 1871574145
Provider Name (Legal Business Name): SURGERY CENTER AT REGENCY PARK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 REGENCY CT STE 101
TOLEDO OH
43623-3075
US

IV. Provider business mailing address

2000 REGENCY CT STE 101
TOLEDO OH
43623-3075
US

V. Phone/Fax

Practice location:
  • Phone: 419-882-0003
  • Fax: 419-882-2195
Mailing address:
  • Phone: 419-882-0003
  • Fax: 419-882-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0091AS
License Number StateOH

VIII. Authorized Official

Name: ROSA M. PEREZ
Title or Position: BUSINESS OFFICE MANGER
Credential:
Phone: 419-882-0003