Provider Demographics
NPI:1285117564
Name:MERCY KENWOOD AMBULATORY SURGERY CENTER LLC
Entity type:Organization
Organization Name:MERCY KENWOOD AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AMBULATORY SVCS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HURLBURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-952-5364
Mailing Address - Street 1:8250 KENWOOD CROSSING WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-3669
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8250 KENWOOD CROSSING WAY STE 102
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-3669
Practice Address - Country:US
Practice Address - Phone:513-952-5364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical