Provider Demographics
NPI:1679577167
Name:WHITEHALL SURGERY CENTER, LTD
Entity Type:Organization
Organization Name:WHITEHALL SURGERY CENTER, LTD
Other - Org Name:PICKERINGTON SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-604-7444
Mailing Address - Street 1:1030 REFUGEE ROAD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147
Mailing Address - Country:US
Mailing Address - Phone:614-604-7444
Mailing Address - Fax:614-604-7445
Practice Address - Street 1:1030 REFUGEE ROAD
Practice Address - Street 2:SUITE 160
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147
Practice Address - Country:US
Practice Address - Phone:614-604-7444
Practice Address - Fax:614-604-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07551C261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2058571Medicaid
OH2058571Medicaid