Provider Demographics
NPI:1154738508
Name:MIDWEST SURGICAL CENTER LLC
Entity type:Organization
Organization Name:MIDWEST SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INNOCENT
Authorized Official - Middle Name:N
Authorized Official - Last Name:UBUNAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-866-2000
Mailing Address - Street 1:7100 ORCHARD CENTRE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-7978
Mailing Address - Country:US
Mailing Address - Phone:419-866-2082
Mailing Address - Fax:419-866-2010
Practice Address - Street 1:7100 ORCHARD CENTRE DR
Practice Address - Street 2:SUITE A
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-7978
Practice Address - Country:US
Practice Address - Phone:419-866-2082
Practice Address - Fax:419-866-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical