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General NPI Number Information
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NPI Number | 1760470942
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Entity Type | Organization
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Legal Business Name | SAMARITAN NORTH SURGERY CENTER LTD
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 06/11/2009
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Provider Practice Location Address
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Address Line | 9000 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45415-1180
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Country | US
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Telephone | 937-567-5900
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Fax | 937-567-5959
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Provider Business Mailing Address
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Address Line | 9000 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45415-1180
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Country | US
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Telephone | 937-567-5900
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Fax | 937-567-5959
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DAVID P KELLY
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Credential |
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Telephone | 937-567-5984
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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 | 0568AS
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License Number State | OH
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