Healthcare Provider Details

I. General information

NPI: 1720081870
Provider Name (Legal Business Name): ORTHOPAEDIC AMBULATORY SURGICAL INTERVENTION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 WHIPPLE AVE NW
CANTON OH
44720-7134
US

IV. Provider business mailing address

7000 WHIPPLE AVE NW
CANTON OH
44720-7134
US

V. Phone/Fax

Practice location:
  • Phone: 330-498-9898
  • Fax: 234-236-0853
Mailing address:
  • Phone: 330-498-9898
  • Fax: 342-236-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number261QA1903X
License Number StateOH

VIII. Authorized Official

Name: ANNA BRIANT
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 330-498-9898