Provider Demographics
NPI:1891883096
Name:SURGERY CENTER OF SANDUSKY LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF SANDUSKY LLC
Other - Org Name:SURGERY CENTER OF SANDUSKY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-435-8935
Mailing Address - Street 1:2616 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5311
Mailing Address - Country:US
Mailing Address - Phone:419-626-2800
Mailing Address - Fax:419-626-2820
Practice Address - Street 1:2616 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5311
Practice Address - Country:US
Practice Address - Phone:419-626-2800
Practice Address - Fax:419-626-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0508AS367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHN09365631Medicare PIN