Provider Demographics
NPI:1891229795
Name:IPS ASC, LLC
Entity Type:Organization
Organization Name:IPS ASC, LLC
Other - Org Name:GEMINI SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLADSTONE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-843-1370
Mailing Address - Street 1:7071 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-2700
Mailing Address - Country:US
Mailing Address - Phone:419-843-1370
Mailing Address - Fax:419-932-6779
Practice Address - Street 1:1210 GEMINI PL
Practice Address - Street 2:SUITE 301
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-6109
Practice Address - Country:US
Practice Address - Phone:614-987-7174
Practice Address - Fax:614-987-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty