Provider Demographics
NPI:1831474741
Name:CUYAHOGA FALLS SURGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CUYAHOGA FALLS SURGICAL ASSOCIATES, INC.
Other - Org Name:JASON A. FRIED, D.O.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-926-0618
Mailing Address - Street 1:1900 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1404
Mailing Address - Country:US
Mailing Address - Phone:330-926-0618
Mailing Address - Fax:330-926-1565
Practice Address - Street 1:1900 23RD ST
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1404
Practice Address - Country:US
Practice Address - Phone:330-926-0618
Practice Address - Fax:330-926-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007188208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1275575201OtherINDIVIDUAL NPI
OH2417263Medicaid
1275575201OtherINDIVIDUAL NPI
OHFR4104491Medicare PIN