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General NPI Number Information
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NPI Number | 1629053608
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Entity Type | Organization
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Legal Business Name | WRSC ACQUISITION GROUP, LLC
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1930 STATE ROUTE 59
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City | KENT
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State | OH
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Zip | 44240-4112
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Country | US
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Telephone | 330-677-3292
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Fax | 330-677-3624
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Provider Business Mailing Address
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Address Line | 1930 STATE ROUTE 59
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City | KENT
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State | OH
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Zip | 44240-4112
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Country | US
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Telephone | 330-677-3292
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Fax | 330-677-3624
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LAURIE A SIMON
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Credential |
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Telephone | 330-677-3292
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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 | 0027AS
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License Number State | OH
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