Provider Demographics
NPI:1659324705
Name:FOUNDATION SURGERY AFFILIATE OF MIDDLEBURG HEIGHTS, LLC
Entity Type:Organization
Organization Name:FOUNDATION SURGERY AFFILIATE OF MIDDLEBURG HEIGHTS, LLC
Other - Org Name:BIG CREEK SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP AND CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-608-1706
Mailing Address - Street 1:14000 N PORTLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-4003
Mailing Address - Country:US
Mailing Address - Phone:405-608-1766
Mailing Address - Fax:405-608-1866
Practice Address - Street 1:15345 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4825
Practice Address - Country:US
Practice Address - Phone:440-743-8400
Practice Address - Fax:440-743-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0782AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical