Basic Information
| Provider Information | |||||||||
| NPI: | 1689674285 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL OHIO SURGICAL INSTITUTE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6520 W CAMPUS OVAL | ||||||||
| Address2: | |||||||||
| City: | NEW ALBANY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430548726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144132233 | ||||||||
| FaxNumber: | 6144132234 | ||||||||
| Practice Location | |||||||||
| Address1: | 6520 W CAMPUS OVAL | ||||||||
| Address2: | |||||||||
| City: | NEW ALBANY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430548726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144132233 | ||||||||
| FaxNumber: | 6144132234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 02/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | DELVECCHIO | ||||||||
| AuthorizedOfficialFirstName: | MARCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6144132233 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 02/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 0733AS | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 2500752 | 05 | OH | MEDICAID |