Provider Demographics
NPI:1295841666
Name:SURGERY CENTER OF SANDUSKY LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF SANDUSKY LLC
Other - Org Name:SURGERY CENTER OF SANDUSKY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-896-8430
Mailing Address - Street 1:2616 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5311
Mailing Address - Country:US
Mailing Address - Phone:419-626-2800
Mailing Address - Fax:419-626-2820
Practice Address - Street 1:2616 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5311
Practice Address - Country:US
Practice Address - Phone:419-626-2800
Practice Address - Fax:419-626-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
OH0508AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHN03611232Medicare PIN