Provider Demographics
NPI:1538100979
Name:COSHOCTON SURGICAL CLINIC
Entity Type:Organization
Organization Name:COSHOCTON SURGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ARVIND
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-623-4009
Mailing Address - Street 1:PO BOX 1377
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-6377
Mailing Address - Country:US
Mailing Address - Phone:740-295-3360
Mailing Address - Fax:740-295-3363
Practice Address - Street 1:311 S 15TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1873
Practice Address - Country:US
Practice Address - Phone:740-295-3360
Practice Address - Fax:740-622-0636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049654208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0555260Medicaid
OH0555260Medicaid
OH9330721Medicare ID - Type Unspecified