Provider Demographics
NPI:1154412757
Name:SURGICENTER LTD
Entity type:Organization
Organization Name:SURGICENTER LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHINFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-522-3937
Mailing Address - Street 1:1651 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1345
Mailing Address - Country:US
Mailing Address - Phone:740-522-5029
Mailing Address - Fax:740-522-6766
Practice Address - Street 1:1651 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1345
Practice Address - Country:US
Practice Address - Phone:740-522-5029
Practice Address - Fax:740-522-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0086A5261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2258079Medicaid
OH2258079Medicaid