Provider Demographics
NPI:1285664300
Name:PHYSICIANS OUTPATIENT SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:PHYSICIANS OUTPATIENT SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-428-3500
Mailing Address - Street 1:418 GRAND PARK DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4000
Mailing Address - Country:US
Mailing Address - Phone:304-428-3500
Mailing Address - Fax:304-422-7900
Practice Address - Street 1:1933 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-2041
Practice Address - Country:US
Practice Address - Phone:740-423-7557
Practice Address - Fax:740-423-7559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
119897OtherCARELINK
490004533OtherRAILROAD MEDICARE
ASC49113OtherTHE HEALTH PLAN
000000190429OtherANTHEM BLUE CROSS
OH2258471Medicaid
000328563OtherMOUNTAIN STATE BLUE CROSS
WV6904001000Medicaid
OH2258471Medicaid
ASC49113OtherTHE HEALTH PLAN
490004533OtherRAILROAD MEDICARE