Basic Information
| Provider Information | |||||||||
| NPI: | 1386976462 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRAUMA & CRITICAL CARE SURGEONS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 117 | ||||||||
| Address2: | |||||||||
| City: | NORTH OLMSTED | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440700117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888086625 | ||||||||
| FaxNumber: | 8883887188 | ||||||||
| Practice Location | |||||||||
| Address1: | 793 W STATE ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432221551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142345000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2010 | ||||||||
| LastUpdateDate: | 02/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | DIZON | ||||||||
| AuthorizedOfficialFirstName: | VICTOR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6143094211 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Emergency Medical Service Providers | Personal Emergency Response Attendant |
No ID Information.