Provider Demographics
NPI:1386632610
Name:LHZ LIMITED PTR
Entity Type:Organization
Organization Name:LHZ LIMITED PTR
Other - Org Name:SAINT CLARE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEANN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOMBOS
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:330-920-4500
Mailing Address - Street 1:4441 HUDSON DR
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2218
Mailing Address - Country:US
Mailing Address - Phone:330-920-4500
Mailing Address - Fax:330-920-4501
Practice Address - Street 1:4441 HUDSON DR
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2218
Practice Address - Country:US
Practice Address - Phone:330-920-4500
Practice Address - Fax:330-920-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH308261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2017847Medicaid
ST3610821Medicare ID - Type Unspecified