Provider Demographics
NPI:1588611198
Name:COLUMBUS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:COLUMBUS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:812-372-1370
Mailing Address - Street 1:940 N MARR RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2609
Mailing Address - Country:US
Mailing Address - Phone:812-372-1370
Mailing Address - Fax:812-373-9526
Practice Address - Street 1:940 N MARR RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2609
Practice Address - Country:US
Practice Address - Phone:812-372-1370
Practice Address - Fax:812-373-9526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000098215OtherANTHEM
IN000000098215OtherANTHEM