Provider Demographics
NPI:1003103474
Name:NEW ALBANY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:NEW ALBANY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:GITTINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-327-1462
Mailing Address - Street 1:5040 FOREST DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9187
Mailing Address - Country:US
Mailing Address - Phone:614-775-1616
Mailing Address - Fax:614-775-1661
Practice Address - Street 1:5040 FOREST DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8181
Practice Address - Country:US
Practice Address - Phone:614-546-4300
Practice Address - Fax:614-546-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH033180Medicare PIN