Provider Demographics
NPI:1326073826
Name:WESTERVILLE SURGICAL SPECIALISTS LLC
Entity Type:Organization
Organization Name:WESTERVILLE SURGICAL SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:GRISCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:380-898-5561
Mailing Address - Street 1:477 COOPER RD STE 440
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8055
Mailing Address - Country:US
Mailing Address - Phone:380-898-5561
Mailing Address - Fax:380-898-5563
Practice Address - Street 1:477 COOPER RD
Practice Address - Street 2:SUITE 440
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8053
Practice Address - Country:US
Practice Address - Phone:380-898-5561
Practice Address - Fax:380-898-5563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042997174400000X
208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2845676Medicaid
OH9345121OtherMEDICARE PTAN