Provider Demographics
NPI:1063514107
Name:OHIO SURGERY CENTER LLC
Entity type:Organization
Organization Name:OHIO SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHARIMAN OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-451-0500
Mailing Address - Street 1:930 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1906
Mailing Address - Country:US
Mailing Address - Phone:614-451-0500
Mailing Address - Fax:614-451-2844
Practice Address - Street 1:930 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1906
Practice Address - Country:US
Practice Address - Phone:614-451-0500
Practice Address - Fax:614-451-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH386261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH2070646Medicaid
OH3611061Medicare ID - Type Unspecified