Provider Demographics
NPI:1649456021
Name:POLARIS SURGERY CENTER, LLC
Entity type:Organization
Organization Name:POLARIS SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BULTEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-566-0568
Mailing Address - Street 1:300 POLARIS PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7971
Mailing Address - Country:US
Mailing Address - Phone:614-566-0568
Mailing Address - Fax:614-566-0608
Practice Address - Street 1:300 POLARIS PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7971
Practice Address - Country:US
Practice Address - Phone:614-566-0568
Practice Address - Fax:614-566-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical