1376512194 NPI number — LORRAINE SURGICAL SUPPLY INC

Table of content: (NPI 1376512194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376512194 NPI number — LORRAINE SURGICAL SUPPLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LORRAINE SURGICAL SUPPLY INC
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:
6
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:
1376512194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27911 FRANKLIN PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91355-4110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-294-4200
Provider Business Mailing Address Fax Number:
661-294-1042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17520 ENGLE LAKE DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURG HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44130-8360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-281-4777
Provider Business Practice Location Address Fax Number:
216-281-4940
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUOR
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP GENERAL MANAGER
Authorized Official Telephone Number:
661-294-4200

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0276786 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 792625100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000155418 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0276786 . This is a "BUREAU FOR CHILDREN WITH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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