Provider Demographics
NPI:1376512194
Name:LORRAINE SURGICAL SUPPLY INC
Entity Type:Organization
Organization Name:LORRAINE SURGICAL SUPPLY INC
Other - Org Name:SHIELD HEALTHCARE OH, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF CUSTOMER EXPERIENCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-294-4200
Mailing Address - Street 1:27911 FRANKLIN PKWY
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4110
Mailing Address - Country:US
Mailing Address - Phone:661-294-4200
Mailing Address - Fax:661-294-1042
Practice Address - Street 1:17520 ENGLE LAKE DR STE A
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-8360
Practice Address - Country:US
Practice Address - Phone:216-281-4777
Practice Address - Fax:216-281-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0276786Medicaid
OH0276786OtherBUREAU FOR CHILDREN WITH
MN792625100Medicaid
OH000000155418OtherANTHEM BCBS
OH0276786Medicaid
OH0276786Medicaid