Healthcare Provider Details

I. General information

NPI: 1700815552
Provider Name (Legal Business Name): SURGCENTER HUDSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 DARROW RD STE 109
HUDSON OH
44236-5021
US

IV. Provider business mailing address

2215 E WATERLOO RD STE 313
AKRON OH
44312-3856
US

V. Phone/Fax

Practice location:
  • Phone: 330-208-2720
  • Fax: 330-208-2721
Mailing address:
  • Phone: 330-208-2720
  • Fax: 330-208-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0781AS
License Number StateOH

VIII. Authorized Official

Name: WALID G LABABIDI
Title or Position: PRESIDENT
Credential: CRNA
Phone: 330-208-2720