Organization
CLINTON COUNTY SURGICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN ONDULICK (OWNER)
(937) 383-4111
Entity
Organization
Contact information
Practice address
630 W MAIN ST, SUITE 308, WILMINGTON, OH 45177-2170
(937) 383-4111
Mailing address
630 W MAIN ST, SUITE 308, WILMINGTON, OH 45177-2170
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2865234
—
OH
Enumeration date
03/27/2006
Last updated
01/07/2011
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