Organization · NPI-2
11th St Surgical LLC
Clinic/Center, Ambulatory Surgical · Portsmouth, OH
NPI number1215620877
StatusActive
Last updated in NPPESApr 24, 2024
Details
- NPI
- 1215620877
- Entity type
- Organization (NPI-2)
- Legal business name
- 11th St Surgical LLC
- Organization subpart
- No
- Enumeration date
- May 31, 2023
- Certification date
- Apr 24, 2024
- Last updated
- Apr 24, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QA1903X | Clinic/Center, Ambulatory Surgical | – | – | Yes |
| 261QS0132X | Clinic/Center, Ophthalmologic Surgery | – | – |
Practice location
1534 11th StPortsmouth, OH 45662-4524
Phone 740-355-1161
Mailing address
1534 11th StPortsmouth, OH 45662-4524
Phone 740-355-1161
Authorized official
Tillie Andrade
Credentialing Specialist
7024499173
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