=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255578936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST CENTRAL SURGICAL CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2009
-----------------------------------------------------
Last Update Date | 05/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7055 W CENTRAL AVE
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43617-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-843-1370
-----------------------------------------------------
Fax | 419-843-1362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7055 W CENTRAL AVE
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43617-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-843-1370
-----------------------------------------------------
Fax | 419-843-1362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. WILLIAM G JAMES JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 419-843-1370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | NA03633
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | NA01265
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------