MEDICARE: CLINTON COUNTY OUTPATIENT SURGERY, 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	261QA1903X	Ambulatory Surgical Clinic/Center

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	:	1831287580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTON COUNTY OUTPATIENT SURGERY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 712590
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45271-0001
Country	:	US
Telephone Number	:	513-605-4800
Fax Number	:	513-605-4805

Provider Business Practice Location Address
First Line	:	1150 W LOCUST ST
Second Line	:	SUITE 200
City	:	WILMINGTON
State	:	OH
Zip	:	45177-2572
Country	:	US
Telephone Number	:	937-383-0088
Fax Number	:	937-382-4654

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. PAMELA B LEWIS
Credential	:	R.N.
Telephone Number	:	513-605-4800

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	10/29/2012

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