1487631891 NPI number — SURGICENTER GROUP, LLC

Table of content: (NPI 1487631891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487631891 NPI number — SURGICENTER GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICENTER GROUP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RICHMOND SURGERY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487631891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47375-0457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-966-1945
Provider Business Mailing Address Fax Number:
765-966-2975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 CHESTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47374-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-966-1776
Provider Business Practice Location Address Fax Number:
765-962-1191
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCRIPTURE
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PART OWNER
Authorized Official Telephone Number:
765-966-1945

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0982610 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com