Provider Demographics
NPI:1063492437
Name:SIDNEY ASC LLC
Entity Type:Organization
Organization Name:SIDNEY ASC LLC
Other - Org Name:VALLEY REGIONAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLENDENIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:283 LOONEY RD
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-4147
Mailing Address - Country:US
Mailing Address - Phone:937-778-3848
Mailing Address - Fax:937-778-3853
Practice Address - Street 1:283 LOONEY RD
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-4147
Practice Address - Country:US
Practice Address - Phone:937-778-3848
Practice Address - Fax:937-778-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0321AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2004262Medicaid
OH3610731Medicare PIN
OH36C0001073Medicare Oscar/Certification