Marysville Ohio Surgical Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0751AS Issued in OH

Legal business name

MARYSVILLE OHIO SURGICAL CENTER

Practice address

122 Proffessional Pkwy
Marysville, OH 43040-8053

Phone

(937) 642-6622

Fax

(937) 642-6635

NPI assigned

Apr 12, 2006

Last updated

Mar 19, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jo Ellen Braden, RN

Title

Administrator

Phone

(937) 642-6622

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205884800000",
    "number": "1033173711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 PROFFESSIONAL PKWY",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430408053",
            "telephone_number": "937-642-6622",
            "fax_number": "937-642-6635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 PROFFESSIONAL PKWY",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430408053",
            "telephone_number": "937-642-6622",
            "fax_number": "937-642-6635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYSVILLE OHIO SURGICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-12",
        "last_updated": "2008-03-19",
        "status": "A",
        "authorized_official_last_name": "BRADEN",
        "authorized_official_first_name": "JO ELLEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "937-642-6622",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OH",
            "license": "0751AS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2538409",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Robert Russell Massie, LICDC

• Ambulatory Surgical Clinic/Center in Marysville, OH
• Providers in Marysville, OH by specialty
• Ambulatory Surgical Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.