Provider Demographics
NPI:1801891296
Name:WEST CENTRAL OHIO SURGERY & ENDOSCOPY CENTER, LLC
Entity type:Organization
Organization Name:WEST CENTRAL OHIO SURGERY & ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CASC
Authorized Official - Phone:419-226-8701
Mailing Address - Street 1:770 W HIGH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5900
Mailing Address - Country:US
Mailing Address - Phone:419-226-8700
Mailing Address - Fax:419-226-8799
Practice Address - Street 1:770 W HIGH ST
Practice Address - Street 2:STE 100
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5900
Practice Address - Country:US
Practice Address - Phone:419-226-8700
Practice Address - Fax:419-226-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0577AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2149755Medicaid
OH2149755Medicaid