Provider Demographics
NPI:1255323879
Name:PICKAWAY SURGICAL CENTER LTD
Entity Type:Organization
Organization Name:PICKAWAY SURGICAL CENTER LTD
Other - Org Name:PHYSICIANS AMBULATORY SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-420-9440
Mailing Address - Street 1:1235 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-2108
Mailing Address - Country:US
Mailing Address - Phone:740-420-9440
Mailing Address - Fax:
Practice Address - Street 1:1235 S COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-2108
Practice Address - Country:US
Practice Address - Phone:740-420-9440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0608AS261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2342370Medicaid
OH2342370Medicaid