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Organization
SOUTHWEST SURGICAL PARTNERS LLC
Active
Organization
SOUTHWEST SURGICAL PARTNERS LLC
Active
Other names
Beavercreek Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY GAULT (ADMINISTRATOR)
(937) 458-4201
Entity
Organization
Contact information
Practice address
3559 KEMP RD, SUITE 120, BEAVERCREEK, OH 45431-2533
(937) 458-4100
(937) 458-4119
Mailing address
3559 KEMP RD, SUITE 120, BEAVERCREEK, OH 45431-2533
(937) 458-4100
(937) 458-4119
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0558AS
OH
Other
Enumeration date
01/16/2006
Last updated
08/22/2020
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