Provider Demographics
NPI:1093710873
Name:DUBLIN SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:DUBLIN SURGICAL CENTER, LLC
Other - Org Name:COLUMBUS SURGICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:PURR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-932-9548
Mailing Address - Street 1:5005 PARKCENTER AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3582
Mailing Address - Country:US
Mailing Address - Phone:614-932-9548
Mailing Address - Fax:614-932-9549
Practice Address - Street 1:5005 PARKCENTER AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3582
Practice Address - Country:US
Practice Address - Phone:614-932-9548
Practice Address - Fax:614-932-9549
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
OH0731AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000317382OtherANTHEM ASC PROVIDER NUMBE
NDP00119531OtherMEDICARE RAILROAD ASC
OH2474719Medicaid
OH311256934004OtherTRICARE FOR LIFE
OH2474719Medicaid
NDP00119531OtherMEDICARE RAILROAD ASC
OH=========002OtherMEDICAL MUTUAL OF OHIO AS
OH=========027OtherASC PROVIDER NUMBER