Provider Demographics
NPI:1821095910
Name:SURGERY CENTER
Entity Type:Organization
Organization Name:SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-826-3240
Mailing Address - Street 1:19250 BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3314
Mailing Address - Country:US
Mailing Address - Phone:440-826-3240
Mailing Address - Fax:440-816-0273
Practice Address - Street 1:19250 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3314
Practice Address - Country:US
Practice Address - Phone:440-826-3240
Practice Address - Fax:440-816-0273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0041AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000157345OtherANTHEM
OH6800051OtherUNITED HEALTHCARE
OH6800051OtherUHC MEDICRE COMPLETE
OH0584318Medicaid
OH1411062OtherUNITED MINEWORKERS
OH000000157345OtherANTHEM SENIOR ADVANTAGE
OH1411062OtherUNITED MINEWORKERS
OH=========00OtherWORKERS COMPENSATION
OH=========028OtherCARESOURCE
OH3610041Medicare ID - Type Unspecified
OH49000325Medicare ID - Type UnspecifiedRAILROAD MEDICARE