Provider Demographics
NPI:1154476075
Name:LORAIN SURGICAL SPECIALTIES, INC
Entity Type:Organization
Organization Name:LORAIN SURGICAL SPECIALTIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:I
Authorized Official - Last Name:MORONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-985-1802
Mailing Address - Street 1:20545 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3430
Mailing Address - Country:US
Mailing Address - Phone:440-333-6545
Mailing Address - Fax:440-331-7710
Practice Address - Street 1:530 N LEAVITT RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1131
Practice Address - Country:US
Practice Address - Phone:440-985-1802
Practice Address - Fax:440-985-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID NUMBER
OH0800280001Medicare NSC
OH=========OtherTAX ID NUMBER