Provider Demographics
NPI:1437129772
Name:NEWARK AMBULATORY SURGERY CENTER
Entity Type:Organization
Organization Name:NEWARK AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-788-6010
Mailing Address - Street 1:2000 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1183
Mailing Address - Country:US
Mailing Address - Phone:740-788-6010
Mailing Address - Fax:740-788-6002
Practice Address - Street 1:2000 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1183
Practice Address - Country:US
Practice Address - Phone:740-788-6010
Practice Address - Fax:740-788-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0470AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2097832Medicaid
OH2097832Medicaid
00883Medicare UPIN