Provider Demographics
NPI:1013428259
Name:CRYSTAL CLINIC ORTHOPAEDIC CENTER, LLC
Entity Type:Organization
Organization Name:CRYSTAL CLINIC ORTHOPAEDIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNTKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-670-4152
Mailing Address - Street 1:3925 EMBASSY PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1799
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:437 PORTAGE TRL STE B
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3227
Practice Address - Country:US
Practice Address - Phone:330-929-9192
Practice Address - Fax:330-929-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital