MEDICARE: BRAINARD SURGERY CENTER 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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1295240133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAINARD SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	29017 CEDAR ROAD
Second Line	:
City	:	LYNDURST
State	:	OH
Zip	:	44124-7982
Country	:	US
Telephone Number	:	440-460-8000
Fax Number	:	440-460-4225

Provider Business Practice Location Address
First Line	:	29017 CEDAR ROAD
Second Line	:
City	:	LYNDURST
State	:	OH
Zip	:	44124-7982
Country	:	US
Telephone Number	:	440-460-8000
Fax Number	:	440-460-4225

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BAHMAN GUYURON
Credential	:	MD
Telephone Number	:	440-461-7999

Provider Enumeration Date	:	12/13/2017
Last Update Date	:	06/17/2019

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