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General NPI Number Information
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NPI Number | 1437967783
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Entity Type | Organization
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Legal Business Name | EASTGATE SURGERY CENTER LLC
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 4415 AICHOLTZ RD # A
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City | CINCINNATI
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State | OH
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Zip | 45245-1506
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Country | US
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Telephone | 513-952-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 4415 AICHOLTZ RD # A
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City | CINCINNATI
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State | OH
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Zip | 45245-1506
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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 | VP REIMBURSEMENT
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Name | KIMBERLY RALSTON
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Credential |
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Telephone | 419-996-5119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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