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General NPI Number Information
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NPI Number | 1831881135
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Entity Type | Organization
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Legal Business Name | VERTRAE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 4501 LYONS RD
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City | MIAMISBURG
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State | OH
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Zip | 45342-6444
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Country | US
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Telephone | 844-255-2225
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Fax | 833-314-0504
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Provider Business Mailing Address
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Address Line | 4501 LYONS RD
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City | MIAMISBURG
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State | OH
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Zip | 45342-6444
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Country | US
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Telephone | 844-255-2225
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Fax | 833-314-0504
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAMAL WOODS
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Credential | MD
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Telephone | 844-255-2225
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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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