MEDICARE: OHIO CENTER FOR AMBULATORY SURGERY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1285100933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO CENTER FOR AMBULATORY SURGERY, LLC

Provider Business Mailing Address
First Line	:	24025 COMMERCE PARK UNIT 2
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5823
Country	:	US
Telephone Number	:	216-591-1422
Fax Number	:	216-591-1424

Provider Business Practice Location Address
First Line	:	24025 COMMERCE PARK UNIT 2
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5823
Country	:	US
Telephone Number	:	216-591-1422
Fax Number	:	216-591-1424

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. DAVID GRISCHKAN
Credential	:	MD
Telephone Number	:	216-591-1422

Provider Enumeration Date	:	10/21/2018
Last Update Date	:	10/21/2018

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