1043984248 NPI number — NORTHERN OHIO SURGERY CENTER, LLC

Table of content: (NPI 1043984248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043984248 NPI number — NORTHERN OHIO SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN OHIO SURGERY CENTER, 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:
Provider Other Organization Name Type Code:
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:
1043984248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 77075
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44194-0015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-361-0131
Provider Business Mailing Address Fax Number:
216-586-2647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3755 ORANGE PLACE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-353-6959
Provider Business Practice Location Address Fax Number:
216-586-2647
Provider Enumeration Date:
08/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MACINTOSH
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
216-375-1422

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0468167 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1233AS . This is a "LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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