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General NPI Number Information
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NPI Number | 1063633386
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Entity Type | Organization
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Legal Business Name | CLINTON COUNTY SURGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 87 E US HIGHWAY 22 AND 3 SUITE 500
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City | MAINEVILLE
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State | OH
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Zip | 45039-7841
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Country | US
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Telephone | 937-383-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 87 E US HIGHWAY 22 AND 3 SUITE 500
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City | MAINEVILLE
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State | OH
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Zip | 45039-7841
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN ONDULICK
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Credential | DO
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Telephone | 937-383-4111
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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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