Provider Demographics
NPI:1932465887
Name:COLUMBUS SPECIALTY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:COLUMBUS SPECIALTY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:CST
Authorized Official - Phone:812-657-7800
Mailing Address - Street 1:2425 NORTHPARK DR STE 20
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2373
Mailing Address - Country:US
Mailing Address - Phone:812-657-7800
Mailing Address - Fax:812-657-7714
Practice Address - Street 1:2425 NORTHPARK DR STE 20
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2373
Practice Address - Country:US
Practice Address - Phone:812-657-7800
Practice Address - Fax:812-657-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201179820AMedicaid