MEDICARE: MEDINA-SUMMIT AMBULATORY SURGERY CENTER

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	:	1366761397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDINA-SUMMIT AMBULATORY SURGERY CENTER

Provider Business Mailing Address
First Line	:	3780 MEDINA RD
Second Line	:	SUITE 120
City	:	MEDINA
State	:	OH
Zip	:	44256-5947
Country	:	US
Telephone Number	:	330-952-0014
Fax Number	:	330-952-0015

Provider Business Practice Location Address
First Line	:	3780 MEDINA RD
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-5947
Country	:	US
Telephone Number	:	330-952-0014
Fax Number	:	330-952-0015

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. VICTORIA J. MESHEKOW
Credential	:	RN
Telephone Number	:	330-309-5415

Provider Enumeration Date	:	06/01/2010
Last Update Date	:	03/30/2011

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