Basic Information
| Provider Information | |||||||||
| NPI: | 1629664156 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OSU WEXNER MEDICAL CENTER AMBULATORY SURGERY CENTER | ||||||||
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| OtherOrganizationName: | OSU WEXNER MEDICAL CENTER AMUBLATORY SURGERY CENTER NEW ALBANY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 ACKERMAN RD RM 443 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432024500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148148100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6100 N HAMILTON RD SUITE 2D | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430812062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148148100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2020 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | LARMORE | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6146859420 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OSU WEXNER MEDICAL CENTER AMBULATORY SURGERY CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.