Provider Demographics
NPI:1558345033
Name:SURGERY ALLIANCE LTD
Entity Type:Organization
Organization Name:SURGERY ALLIANCE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-821-7997
Mailing Address - Street 1:975 SAWBURG AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-3515
Mailing Address - Country:US
Mailing Address - Phone:330-821-7997
Mailing Address - Fax:330-821-7295
Practice Address - Street 1:975 SAWBURG AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-3515
Practice Address - Country:US
Practice Address - Phone:330-821-7997
Practice Address - Fax:330-821-7295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0030AS261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0177393Medicaid
OH3610621Medicare ID - Type Unspecified