=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831287580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINTON COUNTY OUTPATIENT SURGERY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 10/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1150 W LOCUST ST SUITE 200
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45177-2572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-383-0088
-----------------------------------------------------
Fax | 937-382-4654
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 712590
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45271-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-605-4800
-----------------------------------------------------
Fax | 513-605-4805
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. PAMELA B LEWIS
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 513-605-4800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------