MEDICARE: CLINTON COUNTY SURGICAL ASSOCIATES, LLC

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	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063633386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTON COUNTY SURGICAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	87 E US HIGHWAY 22 AND 3
Second Line	:	SUITE 500
City	:	MAINEVILLE
State	:	OH
Zip	:	45039-7841
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	87 E US HIGHWAY 22 AND 3
Second Line	:	SUITE 500
City	:	MAINEVILLE
State	:	OH
Zip	:	45039-7841
Country	:	US
Telephone Number	:	937-383-4111
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRIAN ONDULICK
Credential	:	DO
Telephone Number	:	937-383-4111

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	01/07/2011

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