Provider Demographics
NPI:1831287580
Name:CLINTON COUNTY OUTPATIENT SURGERY, INC.
Entity type:Organization
Organization Name:CLINTON COUNTY OUTPATIENT SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:513-605-4800
Mailing Address - Street 1:PO BOX 712590
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-0001
Mailing Address - Country:US
Mailing Address - Phone:513-605-4800
Mailing Address - Fax:513-605-4805
Practice Address - Street 1:1150 W LOCUST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2572
Practice Address - Country:US
Practice Address - Phone:937-383-0088
Practice Address - Fax:937-382-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2052531Medicaid
OH2052531Medicaid