Provider Demographics
NPI:1174571970
Name:DCR SURGERY CENTER, LLC
Entity type:Organization
Organization Name:DCR SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-938-6484
Mailing Address - Street 1:245 W ELMWOOD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4259
Mailing Address - Country:US
Mailing Address - Phone:937-938-6484
Mailing Address - Fax:937-723-9837
Practice Address - Street 1:245 W ELMWOOD DR STE 100
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4259
Practice Address - Country:US
Practice Address - Phone:937-938-6484
Practice Address - Fax:937-723-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0715AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2632575Medicaid
OH000000313565OtherANTHEM
OH2632575Medicaid