Provider Demographics
NPI:1063565547
Name:SHELBY COUNTY SURGICAL ASSOC INC
Entity type:Organization
Organization Name:SHELBY COUNTY SURGICAL ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-492-2094
Mailing Address - Street 1:915 W MICHIGAN STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2491
Mailing Address - Country:US
Mailing Address - Phone:937-492-2094
Mailing Address - Fax:937-492-1768
Practice Address - Street 1:915 WEST MICHIGAN STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2491
Practice Address - Country:US
Practice Address - Phone:937-492-2094
Practice Address - Fax:937-492-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000026762OtherANTHEM GROUP NUMBER
OHC14899OtherTRAVLERS RR GROUP NUMBER
OH4480806OtherAETNA GROUP NUMBER
OH0703555Medicaid
OHC14899OtherTRAVLERS RR GROUP NUMBER
OH=========00OtherWORKERS COMP GROUP NUMBER