Provider Demographics
NPI:1740398890
Name:THE SURGERY CENTER AT SOUTHWOODS, LLC
Entity Type:Organization
Organization Name:THE SURGERY CENTER AT SOUTHWOODS, LLC
Other - Org Name:THE SURGICAL HOSPITAL AT SOUTHWOODS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MURANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-758-1954
Mailing Address - Street 1:7630 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5633
Mailing Address - Country:US
Mailing Address - Phone:330-758-1954
Mailing Address - Fax:330-758-3254
Practice Address - Street 1:7630 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5633
Practice Address - Country:US
Practice Address - Phone:330-758-1954
Practice Address - Fax:330-758-3254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0046AS261QA1903X
OH1485282N00000X
284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36-0352OtherCMS CERTIFICATION NUMBER
OH2369619Medicaid
OH2369619Medicaid