Provider Demographics
NPI:1558451583
Name:LIPPY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:LIPPY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:THEODOSOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-260-7810
Mailing Address - Street 1:3893 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4706
Mailing Address - Country:US
Mailing Address - Phone:330-856-3075
Mailing Address - Fax:330-856-1187
Practice Address - Street 1:3893 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4706
Practice Address - Country:US
Practice Address - Phone:330-856-3075
Practice Address - Fax:330-856-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical