NPIMap

Organization Active NPI

Clinton County Surgical Associates, LLC

  • Surgery Physician
  • Wilmington, OH
National Provider Identifier
1902866585
Registry record updated Jan 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
CLINTON COUNTY SURGICAL ASSOCIATES, LLC
Practice address
630 W Main St
Suite 308
Wilmington, OH 45177-2170
Phone
(937) 383-4111
NPI assigned
Mar 27, 2006
Last updated
Jan 7, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2011

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

Authorized official

Name
Brian OndulickNPI 1336129485
Title
Owner
Phone
(937) 383-4111

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
Surgery Physician 208600000X Primary

Addresses

Primary practice location

630 W Main St
Suite 308
Wilmington, OH 45177-2170

Mailing address

630 W Main St
Suite 308
Wilmington, OH 45177-2170

Other identifiers 1

IdentifierTypeStateIssuer
2865234MedicaidOH

National Provider Directory

National Provider Directory

Locations

630 W Main St
Ste 308
Wilmington, OH 45177
Phone (937) 383-4111

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294358400000",
    "number": "1902866585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 W MAIN ST",
            "address_2": "SUITE 308",
            "city": "WILMINGTON",
            "state": "OH",
            "postal_code": "451772170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 W MAIN ST",
            "address_2": "SUITE 308",
            "city": "WILMINGTON",
            "state": "OH",
            "postal_code": "451772170",
            "telephone_number": "937-383-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINTON COUNTY SURGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2011-01-07",
        "status": "A",
        "authorized_official_last_name": "ONDULICK",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "937-383-4111"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2865234",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2011; 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.