Provider Demographics
NPI:1053316802
Name:OAKVIEW SURGICAL CENTER, INC.
Entity Type:Organization
Organization Name:OAKVIEW SURGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:CLARKE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:574-224-7500
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-0548
Mailing Address - Country:US
Mailing Address - Phone:574-224-7500
Mailing Address - Fax:574-223-6050
Practice Address - Street 1:120 E 18TH ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-2632
Practice Address - Country:US
Practice Address - Phone:574-224-7500
Practice Address - Fax:574-223-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN008092261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT34901Medicare UPIN
INZR2000Medicare ID - Type Unspecified