NPIMap

Organization Active NPI

Midwest Surgical Center LLC

  • Ambulatory Surgical Clinic/Center
  • Holland, OH
National Provider Identifier
1154738508
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
MIDWEST SURGICAL CENTER LLC
Practice address
7100 Orchard Centre Dr
Suite a
Holland, OH 43528-7978
Phone
(419) 866-2082
Fax
(419) 866-2010
NPI assigned
Jul 17, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2023

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

Authorized official

Name
Dr. Innocent N Ubunama, DONPI 1427119981
Title
Owner
Phone
(419) 866-2000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

7100 Orchard Centre Dr
Suite a
Holland, OH 43528-7978

Mailing address

7100 Orchard Centre Dr
Suite a
Holland, OH 43528-7978
Phone (419) 866-2082

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200304001819 OH Part B Supplier - Ambulatory Surgical Center 4880900562 Practice locations: Holland, OH

Ambulatory surgical center certification: CCN 36C0001355

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Midwest Surgical Center LLC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Nov 10, 2023
Last certification
Oct 13, 2023
Ownership / control type
Proprietary
Facility address
7100 Orchard Centre Drive
Holland, OH 43528

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2087047Midwest Surgical Center7100 Orchard Centre Dr, Holland, OH 43528Certificate of waiverNov 16, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1405555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701734400000",
    "number": "1154738508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7100 ORCHARD CENTRE DR",
            "address_2": "SUITE A",
            "city": "HOLLAND",
            "state": "OH",
            "postal_code": "435287978",
            "telephone_number": "419-866-2082",
            "fax_number": "419-866-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7100 ORCHARD CENTRE DR",
            "address_2": "SUITE A",
            "city": "HOLLAND",
            "state": "OH",
            "postal_code": "435287978",
            "telephone_number": "419-866-2082",
            "fax_number": "419-866-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST SURGICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-17",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A",
        "authorized_official_last_name": "UBUNAMA",
        "authorized_official_first_name": "INNOCENT",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-866-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, OH

Sources for this page

Verify at the official NPI Registry.