Provider Demographics
NPI:1497934517
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:
Authorized Official - First Name:ROSEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMBOS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
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?:Yes
Parent Organization LBN:LHZ LIMITED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-25
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN214502367500000X
OHRN214493367500000X
OHRN237894367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2039083Medicaid
OH2039083Medicaid