Provider Demographics
NPI:1891742029
Name:LIMA SURGICAL SPECIALIST, INC
Entity Type:Organization
Organization Name:LIMA SURGICAL SPECIALIST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:F
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-998-8250
Mailing Address - Street 1:# L-3713
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:419-998-8250
Mailing Address - Fax:419-998-8251
Practice Address - Street 1:2981 STONEYBROOK DR
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-3896
Practice Address - Country:US
Practice Address - Phone:419-998-8250
Practice Address - Fax:419-998-8251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH82114208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDC7087OtherRAILROAD MEDICARE
OHDC7087OtherRAILROAD MEDICARE