1891793915 NPI number — NORTHEAST OHIO SURGERY CENTER, LLC

Table of content: (NPI 1891793915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891793915 NPI number — NORTHEAST OHIO SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST 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:
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:
1891793915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3755 ORANGE PLACE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ORANGE VILLAGE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-4455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-360-9610
Provider Business Mailing Address Fax Number:
216-360-9606

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:
ORANGE VILLAGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-4455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-360-9610
Provider Business Practice Location Address Fax Number:
216-360-9606
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
YOKIEL
Authorized Official First Name:
JEROME
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PRESIDENT, MEDICAL DIRECTOR
Authorized Official Telephone Number:
216-360-9610

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  0673AS , 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: 000000227520 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 490005606 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2391737 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 352498400 . This is a "OHIO DEPT OF LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com