=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992882153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KNIGHTSBRIDGE SURGERY CENTER, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4845 KNIGHTSBRIDGE BLVD SUITE 110
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43214-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-273-0400
-----------------------------------------------------
Fax | 614-273-0401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4845 KNIGHTSBRIDGE BLVD SUITE 110
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43214-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-273-0400
-----------------------------------------------------
Fax | 614-273-0401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRMAN OF THE BOARD
-----------------------------------------------------
Name | DR. PHILIP H TAYLOR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 614-273-0400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 0654AS
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------