Provider Demographics
NPI:1629664156
Name:OSU WEXNER MEDICAL CENTER AMBULATORY SURGERY CENTER
Entity type:Organization
Organization Name:OSU WEXNER MEDICAL CENTER AMBULATORY SURGERY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-293-8000
Mailing Address - Street 1:660 ACKERMAN RD RM 443
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-4500
Mailing Address - Country:US
Mailing Address - Phone:614-293-8000
Mailing Address - Fax:
Practice Address - Street 1:6100 N HAMILTON RD SUITE 2D
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2062
Practice Address - Country:US
Practice Address - Phone:614-814-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSU WEXNER MEDICAL CENTER AMBULATORY SURGERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-18
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0477873Medicaid