Provider Demographics
NPI:1932248572
Name:MIDDLETOWN SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:MIDDLETOWN SURGICAL ASSOCIATES
Other - Org Name:THE SURGICAL WEIGHT LOSS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-222-5330
Mailing Address - Street 1:1 ELIZABETH PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45408-1445
Mailing Address - Country:US
Mailing Address - Phone:937-222-5330
Mailing Address - Fax:937-222-5332
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1445
Practice Address - Country:US
Practice Address - Phone:937-222-5330
Practice Address - Fax:937-222-5332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH038460174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty