=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710069711
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SURGEONS OFFICE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 08/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 495 COOPER RD STE 430
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43081-8780
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-508-0001
-----------------------------------------------------
Fax | 614-508-0008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 495 COOPER RD STE 430
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43081-8780
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-508-0001
-----------------------------------------------------
Fax | 614-508-0008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KIM S HAMELBERG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 614-508-0001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 57243
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------