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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2139948
—
OH
Enumeration date
01/16/2006
Last updated
08/22/2020
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