Provider Demographics
NPI:1811983364
Name:NORTHERN OHIO SURGICAL CENTER
Entity type:Organization
Organization Name:NORTHERN OHIO SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-627-8557
Mailing Address - Street 1:2800 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7248
Mailing Address - Country:US
Mailing Address - Phone:419-627-8557
Mailing Address - Fax:419-627-8559
Practice Address - Street 1:2800 HAYES AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7248
Practice Address - Country:US
Practice Address - Phone:419-627-8557
Practice Address - Fax:419-627-8559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0628AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2215757Medicaid
OH000000227672OtherANTHEM
OH=========00OtherWORKERS COMP
OH2215757Medicaid
OH=========002OtherMEDICAL MUTUAL