Provider Demographics
NPI:1649462409
Name:OHIO VALLEY AMBULATORY SURGERY CENTER, LLC
Entity type:Organization
Organization Name:OHIO VALLEY AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CATALINO
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-615-0655
Mailing Address - Street 1:608 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-2465
Mailing Address - Country:US
Mailing Address - Phone:740-423-4684
Mailing Address - Fax:740-423-4694
Practice Address - Street 1:608 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-2465
Practice Address - Country:US
Practice Address - Phone:740-423-4684
Practice Address - Fax:740-423-4694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810013278Medicaid
WV3810013278Medicaid