MEDICARE: OAKVIEW SURGICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP1100X	Podiatric Clinic/Center	008092	IN

General Provider Information

NPI Number	:	1053316802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKVIEW SURGICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 548
Second Line	:
City	:	ROCHESTER
State	:	IN
Zip	:	46975-0548
Country	:	US
Telephone Number	:	574-224-7500
Fax Number	:	574-223-6050

Provider Business Practice Location Address
First Line	:	120 E 18TH ST
Second Line	:
City	:	ROCHESTER
State	:	IN
Zip	:	46975-2632
Country	:	US
Telephone Number	:	574-224-7500
Fax Number	:	574-223-3057

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	DR. LAURENCE CLARKE ROGERS
Credential	:	D.P.M.
Telephone Number	:	574-224-7500

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	08/22/2020

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