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General NPI Number Information
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NPI Number | 1255323879
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Entity Type | Organization
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Legal Business Name | PICKAWAY SURGICAL CENTER LTD
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 1235 S COURT ST
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City | CIRCLEVILLE
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State | OH
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Zip | 43113-2108
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Country | US
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Telephone | 740-420-9440
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 S COURT ST
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City | CIRCLEVILLE
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State | OH
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Zip | 43113-2108
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Country | US
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Telephone | 740-420-9440
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. TRACY MALONEY
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Credential |
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Telephone | 740-420-9440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 0608AS
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License Number State | OH
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