MEDICARE: 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	0041AS	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000157345	OTHER	OH	ANTHEM
2	6800051	OTHER	OH	UNITED HEALTHCARE
3	6800051	OTHER	OH	UHC MEDICRE COMPLETE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1411062	OTHER	OH	UNITED MINEWORKERS
6	000000157345	OTHER	OH	ANTHEM SENIOR ADVANTAGE

General Provider Information

NPI Number	:	1821095910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGERY CENTER

Provider Business Mailing Address
First Line	:	19250 BAGLEY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3314
Country	:	US
Telephone Number	:	440-826-3240
Fax Number	:	440-816-0273

Provider Business Practice Location Address
First Line	:	19250 BAGLEY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3314
Country	:	US
Telephone Number	:	440-826-3240
Fax Number	:	440-816-0273

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. BARBARA DRAVES
Credential	:
Telephone Number	:	440-826-3240

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	09/27/2010

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Practice Location Address:

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Directions to “SURGERY CENTER ” Practice Location

Language	Start Address	Practice Location

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