MEDICARE: CLEVELAND CHILDRENS SURGERY CENTER LLC

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

General Provider Information

NPI Number	:	1356814958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND CHILDRENS SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	182 INDUSTRIAL RD
Second Line	:
City	:	GLEN ROCK
State	:	PA
Zip	:	17327-8626
Country	:	US
Telephone Number	:	717-759-4375
Fax Number	:	717-759-4336

Provider Business Practice Location Address
First Line	:	7690 FIRST PL STE E
Second Line	:
City	:	BEDFORD
State	:	OH
Zip	:	44146-6725
Country	:	US
Telephone Number	:	216-539-8253
Fax Number	:	216-302-3416

Authorized Official
Title or Position	:	CEO
Name	:	RAYMOND FIGUEROA
Credential	:
Telephone Number	:	717-759-4375

Provider Enumeration Date	:	01/07/2019
Last Update Date	:	02/04/2019

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