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General NPI Number Information
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NPI Number | 1528050945
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Entity Type | Organization
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Legal Business Name | SOUTHERN OHIO SURGICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 1711 27TH ST BRAUNLIN BLDG, SUITE 306
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2638
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Country | US
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Telephone | 740-353-8661
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Fax | 740-354-3254
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Provider Business Mailing Address
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Address Line | 1711 27TH ST BRAUNLIN BLDG, SUITE 306
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2638
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Country | US
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Telephone | 740-353-8661
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Fax | 740-354-3254
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS L KHOURY
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Credential | M.D.
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Telephone | 740-353-8661
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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 | 35-06-5158-K
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 50-00-1711
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35-84596
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License Number State | OH
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