=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053494575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHLAND SURGICAL ASSOCIATES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 HILLCREST DR
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44805-4052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-281-0451
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 22958
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-0958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-595-9600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARY CAREY MACDONALD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 419-281-0451
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------