Basic Information
| Provider Information | |||||||||
| NPI: | 1477853901 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANDERSON SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7691 5 MILE RD | ||||||||
| Address2: | SUITE 10 B | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452304348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136247246 | ||||||||
| FaxNumber: | 9376246900 | ||||||||
| Practice Location | |||||||||
| Address1: | 7691 5 MILE RD | ||||||||
| Address2: | SUITE 10 B | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452304348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136247246 | ||||||||
| FaxNumber: | 9376246900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2010 | ||||||||
| LastUpdateDate: | 04/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | KHAN | ||||||||
| AuthorizedOfficialFirstName: | MUKARRAM | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5136247246 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.