MEDICARE: SURGICENTER OF MANSFIELD, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	0469AS	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093705774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICENTER OF MANSFIELD, LTD.

Provider Business Mailing Address
First Line	:	1030 CRICKET LN
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-4104
Country	:	US
Telephone Number	:	419-774-9410
Fax Number	:	419-774-1072

Provider Business Practice Location Address
First Line	:	1030 CRICKET LN
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-4104
Country	:	US
Telephone Number	:	419-774-9410
Fax Number	:	419-774-1072

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. LINDA S. EFAW
Credential	:
Telephone Number	:	419-774-9410

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	08/22/2020

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