Healthcare Provider Details

I. General information

NPI: 1417937756
Provider Name (Legal Business Name): CLEVELAND ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5106 WILSON MILLS RD
RICHMOND HEIGHTS OH
44143-3006
US

IV. Provider business mailing address

15933 CLAYTON RD STE 210
BALLWIN MO
63011-2172
US

V. Phone/Fax

Practice location:
  • Phone: 440-461-2570
  • Fax: 440-461-7109
Mailing address:
  • Phone: 636-227-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0448AS
License Number StateOH

VIII. Authorized Official

Name: JAMES WACHTER
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 636-227-2600