Provider Demographics
NPI:1619257409
Name:ASHTABULA SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ASHTABULA SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:831-588-7296
Mailing Address - Street 1:2893 N RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4134
Mailing Address - Country:US
Mailing Address - Phone:440-998-0000
Mailing Address - Fax:
Practice Address - Street 1:2893 N RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4134
Practice Address - Country:US
Practice Address - Phone:440-998-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical