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 codeDescriptionLicenseStatePrimary
261QA1903X Clinic/Center, Ambulatory Surgical––Yes
261QS0132X Clinic/Center, Ophthalmologic Surgery––

Practice location

1534 11th St
Portsmouth, OH 45662-4524

Phone 740-355-1161

Mailing address

1534 11th St
Portsmouth, OH 45662-4524

Phone 740-355-1161

Authorized official

Tillie Andrade
Credentialing Specialist
7024499173

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