Provider Demographics
NPI: | 1558423095 |
---|---|
Name: | CLEVELAND SURGI-CENTER, INC |
Entity Type: | Organization |
Organization Name: | CLEVELAND SURGI-CENTER, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ACCOUNTS MANAGER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | JENNIFER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HARDING |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 216-295-3330 |
Mailing Address - Street 1: | 3535 LEE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | SHAKER HEIGHTS |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44120-5122 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3535 LEE RD |
Practice Address - Street 2: | |
Practice Address - City: | SHAKER HEIGHTS |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44120-5122 |
Practice Address - Country: | US |
Practice Address - Phone: | 216-295-3330 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-12-14 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 0250286 | Medicaid |