Provider Demographics
NPI:1346050309
Name:WEST CENTRAL OHIO UROLOGICAL CENTERS OF EXCELLENCE, LLC
Entity type:Organization
Organization Name:WEST CENTRAL OHIO UROLOGICAL CENTERS OF EXCELLENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:567-529-9000
Mailing Address - Street 1:2751 FORT AMANDA RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-4805
Mailing Address - Country:US
Mailing Address - Phone:567-529-9000
Mailing Address - Fax:567-529-9001
Practice Address - Street 1:2751 FORT AMANDA RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-4805
Practice Address - Country:US
Practice Address - Phone:567-529-9000
Practice Address - Fax:567-529-9001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NICHOLSON UROLOGY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site