Healthcare Provider Details

I. General information

NPI: 1821095910
Provider Name (Legal Business Name): SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19250 BAGLEY RD
CLEVELAND OH
44130-3314
US

IV. Provider business mailing address

19250 BAGLEY RD
CLEVELAND OH
44130-3314
US

V. Phone/Fax

Practice location:
  • Phone: 440-826-3240
  • Fax: 440-816-0273
Mailing address:
  • Phone: 440-826-3240
  • Fax: 440-816-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0041AS
License Number StateOH

VIII. Authorized Official

Name: MRS. BARBARA DRAVES
Title or Position: ADMINISTRATOR
Credential:
Phone: 440-826-3240