Provider Demographics
NPI:1689674285
Name:CENTRAL OHIO SURGICAL INSTITUTE, LLC
Entity Type:Organization
Organization Name:CENTRAL OHIO SURGICAL INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELVECCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-413-2233
Mailing Address - Street 1:6520 W CAMPUS OVAL
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8726
Mailing Address - Country:US
Mailing Address - Phone:614-413-2233
Mailing Address - Fax:614-413-2234
Practice Address - Street 1:6520 W CAMPUS OVAL
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8726
Practice Address - Country:US
Practice Address - Phone:614-413-2233
Practice Address - Fax:614-413-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0733AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2500752Medicaid
OH2500752Medicaid