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NPI Code Detail

MEDICARE: EASTGATE SURGERY CENTER LLC

MEDICARE: EASTGATE SURGERY CENTER 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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1437967783
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTGATE SURGERY CENTER LLC
Provider Business Mailing Address
First Line : 4415 AICHOLTZ RD # A
Second Line :
City : CINCINNATI
State : OH
Zip : 45245-1506
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4415 AICHOLTZ RD # A
Second Line :
City : CINCINNATI
State : OH
Zip : 45245-1506
Country : US
Telephone Number : 513-952-5000
Fax Number :
Authorized Official
Title or Position : VP REIMBURSEMENT
Name : KIMBERLY RALSTON
Credential :
Telephone Number : 419-996-5119
Provider Enumeration Date : 12/19/2024
Last Update Date : 01/12/2026

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Directions to “EASTGATE SURGERY CENTER LLC ” Practice Location

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