Organization
11TH ST SURGICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TILLIE ANDRADE (CREDENTIALING SPECIALIST)
(702) 449-9173
Entity
Organization
Contact information
Practice address
1534 11TH ST, PORTSMOUTH, OH 45662-4524
(740) 355-1161
Mailing address
1534 11TH ST, PORTSMOUTH, OH 45662-4524
(740) 355-1161
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
261QS0132X
Ophthalmologic Surgery Clinic/Center
—
—
Other
Enumeration date
05/31/2023
Last updated
04/24/2024
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