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General NPI Number Information
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NPI Number | 1700269354
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Entity Type | Organization
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Legal Business Name | SOUTHEAST OHIO SURGICAL SUITES, LLC
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 20 UNIVERSITY ESTATES BLVD SUITE 110
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City | ATHENS
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State | OH
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Zip | 45701-2869
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Country | US
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Telephone | 740-856-9044
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Fax |
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Provider Business Mailing Address
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Address Line | 20 UNIVERSITY ESTATES BLVD SUITE 110
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City | ATHENS
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State | OH
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Zip | 45701-2869
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Country | US
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Telephone | 740-589-7710
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Fax |
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Authorized Official
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Title or Position | OFFICER/AUTHORIZED OFFICIAL
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Name | CHRISTOPHER HARTSHORN
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Credential |
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Telephone | 314-800-2017
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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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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 | 1131AS
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License Number State | OH
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