Organization
SURGERY CENTER OF CINCINNATI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGIL RAY CANTRELL (ADMINISTRATOR)
(513) 947-1130
Entity
Organization
Contact information
Practice address
4415 AICHOLTZ RD, CINCINNATI, OH 45245-1506
(513) 947-1130
(513) 947-8541
Mailing address
4415 AICHOLTZ RD, CINCINNATI, OH 45245-1506
(513) 947-1130
(513) 947-8541
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0587AS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000156597
ANTHEM PROVIDER ID
OH
05
—
200292830A
—
IN
05
—
2185102
—
OH
05
—
36000123
—
KY
01
—
375674700
KENTUCKY WORKERS COMP
KY
01
—
61101
HUMANA PROVIDER ID
OH
Enumeration date
04/07/2006
Last updated
04/12/2011
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