MEDICARE: BIG CREEK SURGICAL HOSPITAL, 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	284300000X	Special Hospital	N/A	OH

General Provider Information

NPI Number	:	1356677488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIG CREEK SURGICAL HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	15345 BAGLEY RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-4825
Country	:	US
Telephone Number	:	440-743-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	15345 BAGLEY RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-4825
Country	:	US
Telephone Number	:	440-743-8400
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. JAMES ROBERT HOLFINGER
Credential	:	D.P.M.
Telephone Number	:	440-743-8400

Provider Enumeration Date	:	10/24/2009
Last Update Date	:	10/24/2009

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