=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053313007
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDRENS SURGERY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 660 CHILDRENS DR
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43205-2649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-722-2920
-----------------------------------------------------
Fax | 614-722-5710
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 660 CHILDRENS DR
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43205-2649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-722-2920
-----------------------------------------------------
Fax | 614-722-5710
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | MR. ALAN TINGLEY
-----------------------------------------------------
Credential | MD, MBA
-----------------------------------------------------
Telephone | 614-722-2920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 334
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------