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General NPI Number Information
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NPI Number | 1174572606
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Entity Type | Organization
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Legal Business Name | NORTH COAST SURGERY CENTER, LLC
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 1170 E BROAD ST SUITE 104
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City | ELYRIA
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State | OH
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Zip | 44035-6351
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Country | US
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Telephone | 440-366-6029
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Fax | 440-366-6064
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Provider Business Mailing Address
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Address Line | 1170 E BROAD ST SUITE 104
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City | ELYRIA
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State | OH
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Zip | 44035-6351
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Country | US
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Telephone | 440-366-6029
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Fax | 440-366-6064
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE COSTARAS
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Credential | D.P.M.
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Telephone | 440-366-6029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 0775AS
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License Number State | OH
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