Provider Demographics
NPI:1710069711
Name:THE SURGEONS OFFICE, INC
Entity Type:Organization
Organization Name:THE SURGEONS OFFICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAMELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-508-0001
Mailing Address - Street 1:495 COOPER RD
Mailing Address - Street 2:STE 430
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8780
Mailing Address - Country:US
Mailing Address - Phone:614-508-0001
Mailing Address - Fax:614-508-0008
Practice Address - Street 1:495 COOPER RD
Practice Address - Street 2:STE 430
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8780
Practice Address - Country:US
Practice Address - Phone:614-508-0001
Practice Address - Fax:614-508-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57243174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0820946Medicaid
OH0820946Medicaid