Provider Demographics
NPI:1184682445
Name:PORTSMOUTH SURGERY CENTER
Entity Type:Organization
Organization Name:PORTSMOUTH SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:800-948-3937
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1498
Mailing Address - Country:US
Mailing Address - Phone:800-948-3937
Mailing Address - Fax:740-477-8349
Practice Address - Street 1:1400 GAY STREET
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3475
Practice Address - Country:US
Practice Address - Phone:800-948-3937
Practice Address - Fax:740-351-0989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2537633Medicaid
OH2537633Medicaid