Provider Demographics
NPI:1760849889
Name:SURGERY CENTER AT CORPORATE WAY LLC
Entity Type:Organization
Organization Name:SURGERY CENTER AT CORPORATE WAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMOL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-434-4111
Mailing Address - Street 1:7076 CORPORATE WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4246
Mailing Address - Country:US
Mailing Address - Phone:937-434-4111
Mailing Address - Fax:937-434-4116
Practice Address - Street 1:7076 CORPORATE WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4246
Practice Address - Country:US
Practice Address - Phone:937-434-4111
Practice Address - Fax:937-434-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical