Provider Demographics
NPI:1578146429
Name:BSMH AMBULATORY VENTURES II LLC
Entity Type:Organization
Organization Name:BSMH AMBULATORY VENTURES II LLC
Other - Org Name:MERCY HEALTH CANFIELD SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-695-0397
Mailing Address - Street 1:4147 WESTFORD PL
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8086
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4147 WESTFORD DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8086
Practice Address - Country:US
Practice Address - Phone:330-702-1489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical