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General NPI Number Information
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NPI Number | 1063565547
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Entity Type | Organization
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Legal Business Name | SHELBY COUNTY SURGICAL ASSOC INC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 915 WEST MICHIGAN STREET SUITE 201
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City | SIDNEY
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State | OH
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Zip | 45365-2491
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Country | US
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Telephone | 937-492-2094
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Fax | 937-492-1768
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Provider Business Mailing Address
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Address Line | 915 W MICHIGAN STREET SUITE 201
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City | SIDNEY
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State | OH
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Zip | 45365-2491
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Country | US
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Telephone | 937-492-2094
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Fax | 937-492-1768
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. SHARON C MAURER
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Credential |
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Telephone | 937-492-2094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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