Healthcare Provider Details

I. General information

NPI: 1811651508
Provider Name (Legal Business Name): CRYSTAL CLINIC ORTHOPAEDIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 10/28/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3557 EMBASSY PKWY STE 1021
AKRON OH
44333-8358
US

IV. Provider business mailing address

PO BOX 72434
CLEVELAND OH
44192-0002
US

V. Phone/Fax

Practice location:
  • Phone: 330-670-4242
  • Fax: 330-670-4241
Mailing address:
  • Phone: 330-668-7428
  • Fax: 330-666-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: DANIEL J FERRY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 330-670-4152