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General NPI Number Information
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NPI Number | 1295841666
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Entity Type | Organization
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Legal Business Name | SURGERY CENTER OF SANDUSKY LLC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 2616 HAYES AVE
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City | SANDUSKY
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State | OH
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Zip | 44870-5311
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Country | US
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Telephone | 419-626-2800
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Fax | 419-626-2820
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Provider Business Mailing Address
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Address Line | 2616 HAYES AVE
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City | SANDUSKY
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State | OH
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Zip | 44870-5311
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Country | US
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Telephone | 419-626-2800
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Fax | 419-626-2820
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MICHELE RENE MANN
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Credential |
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Telephone | 517-896-8430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 0508AS
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License Number State | OH
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