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NPI Code Detail

MEDICARE: SHAKER HEIGHTS SURGICAL CENTER, LLC

MEDICARE: SHAKER HEIGHTS SURGICAL 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
1261QA1903XAmbulatory Surgical Clinic/Center0571ASOH

General Provider Information

NPI Number : 1962663641
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHAKER HEIGHTS SURGICAL CENTER, LLC
Provider Business Mailing Address
First Line : 3535 LEE RD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44120-5122
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3535 LEE RD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44120-5122
Country : US
Telephone Number : 561-368-7118
Fax Number : 561-368-7116
Authorized Official
Title or Position : MBR
Name : MR. CHRIS LIVA
Credential :
Telephone Number : 954-732-3800
Provider Enumeration Date : 06/24/2008
Last Update Date : 06/24/2008

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