Provider Demographics
NPI:1992018790
Name:REVISION ADVANCED SURGERY CENTER INC
Entity Type:Organization
Organization Name:REVISION ADVANCED SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SCHUMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-525-3737
Mailing Address - Street 1:1080 POLARIS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-6035
Mailing Address - Country:US
Mailing Address - Phone:800-475-2113
Mailing Address - Fax:614-781-1974
Practice Address - Street 1:1080 POLARIS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-6035
Practice Address - Country:US
Practice Address - Phone:800-475-2113
Practice Address - Fax:614-781-1974
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REVISION ADVANCED SURGERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-21
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0642AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical