Healthcare Provider Details

I. General information

NPI: 1619257409
Provider Name (Legal Business Name): ASHTABULA SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2893 N RIDGE RD E
ASHTABULA OH
44004-4134
US

IV. Provider business mailing address

2893 N RIDGE RD E
ASHTABULA OH
44004-4134
US

V. Phone/Fax

Practice location:
  • Phone: 440-998-0000
  • Fax:
Mailing address:
  • Phone: 440-998-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LEE JAMES MAREK
Title or Position: OWNER
Credential: DPM
Phone: 831-588-7296