MEDICARE: CRYSTAL CLINIC ORTHOPAEDIC 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	284300000X	Special Hospital	NOT APPLICABLE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669669917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL CLINIC ORTHOPAEDIC CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 72434
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44192-0002
Country	:	US
Telephone Number	:	330-670-1005
Fax Number	:	330-670-4109

Provider Business Practice Location Address
First Line	:	3557 EMBASSY PKWY
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-8358
Country	:	US
Telephone Number	:	330-670-1005
Fax Number	:	330-670-1007

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DANIEL J FERRY
Credential	:
Telephone Number	:	330-670-4152

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	10/29/2025

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