Provider Demographics
NPI:1477558641
Name:UPPER ARLINGTON SURGERY CENTER, LTD.
Entity Type:Organization
Organization Name:UPPER ARLINGTON SURGERY CENTER, LTD.
Other - Org Name:RIVERSIDE OUTPATIENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:COONEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-566-5080
Mailing Address - Street 1:2240 N BANK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-5420
Mailing Address - Country:US
Mailing Address - Phone:614-566-5080
Mailing Address - Fax:614-457-1887
Practice Address - Street 1:2240 N BANK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-5420
Practice Address - Country:US
Practice Address - Phone:614-566-5080
Practice Address - Fax:614-457-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3610771Medicare ID - Type Unspecified