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General NPI Number Information
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NPI Number | 1417958729
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Entity Type | Organization
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Legal Business Name | MENTOR SURGERY CENTER LTD
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 12/31/2014
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Provider Practice Location Address
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Address Line | 9485 MENTOR AVE STE 1
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City | MENTOR
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State | OH
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Zip | 44060-4597
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Country | US
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Telephone | 440-205-5454
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Fax | 440-205-5402
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Provider Business Mailing Address
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Address Line | 9485 MENTOR AVE STE 1
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City | MENTOR
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State | OH
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Zip | 44060-8711
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Country | US
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Telephone | 440-205-5454
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Fax | 440-205-5402
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MISS TRACY ANN PETERS
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Credential | CPC
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Telephone | 440-205-5467
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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 | 0404AS
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License Number State | OH
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