Provider Demographics
NPI:1043984248
Name:NORTHERN OHIO SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:NORTHERN OHIO SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-375-1422
Mailing Address - Street 1:PO BOX 77075
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0015
Mailing Address - Country:US
Mailing Address - Phone:866-361-0131
Mailing Address - Fax:216-586-2647
Practice Address - Street 1:3755 ORANGE PLACE
Practice Address - Street 2:SUITE 102
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-353-6959
Practice Address - Fax:216-586-2647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0468167Medicaid
OH1233ASOtherLICENSE