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General NPI Number Information
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NPI Number | 1740260926
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Entity Type | Organization
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Legal Business Name | STARK AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 4360 FULTON DR NW SUITE C
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City | CANTON
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State | OH
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Zip | 44718-2878
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Country | US
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Telephone | 330-305-2020
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Fax | 330-305-2020
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Provider Business Mailing Address
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Address Line | 4360 FULTON DR NW SUITE C
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City | CANTON
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State | OH
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Zip | 44718-2878
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Country | US
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Telephone | 330-305-2020
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Fax | 330-305-2020
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Authorized Official
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Title or Position | OFFICER/AUTHORIZED OFFICIAL
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Name | CHRISTOPHER HARTSHORN
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Credential |
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Telephone | 314-800-2017
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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 | 0750AS
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License Number State | OH
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