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General NPI Number Information
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NPI Number | 1245202472
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Entity Type | Organization
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Legal Business Name | WILLOUGHBY ASC LLC
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 34940 RIDGE RD SUITE B
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City | WILLOUGHBY
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State | OH
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Zip | 44094-4196
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Country | US
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Telephone | 440-953-8568
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Fax | 440-953-4429
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Provider Business Mailing Address
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Address Line | 34940 RIDGE RD SUITE B
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City | WILLOUGHBY
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State | OH
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Zip | 44094-4196
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Country | US
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Telephone | 440-953-8568
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Fax | 440-953-4429
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILLIP A. CLENDENIN
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Credential |
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Telephone | 615-665-1283
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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 | 0389AS
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License Number State | OH
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