1417937756 NPI number — CLEVELAND ASC LLC

Table of content: (NPI 1417937756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417937756 NPI number — CLEVELAND ASC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEVELAND ASC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLEVELAND SURGICAL SUITES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417937756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15933 CLAYTON RD STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALLWIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63011-2172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-227-2600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5106 WILSON MILLS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44143-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-461-2570
Provider Business Practice Location Address Fax Number:
440-461-7109
Provider Enumeration Date:
01/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WACHTER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
636-227-2600

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  0448AS , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 490003603 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2060639 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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