Provider Demographics
NPI:1295240133
Name:BRAINARD SURGERY CENTER LLC
Entity type:Organization
Organization Name:BRAINARD SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BAHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUYURON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-461-7999
Mailing Address - Street 1:29017 CEDAR ROAD
Mailing Address - Street 2:
Mailing Address - City:LYNDURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-7982
Mailing Address - Country:US
Mailing Address - Phone:440-460-8000
Mailing Address - Fax:440-460-4225
Practice Address - Street 1:29017 CEDAR ROAD
Practice Address - Street 2:
Practice Address - City:LYNDURST
Practice Address - State:OH
Practice Address - Zip Code:44124-7982
Practice Address - Country:US
Practice Address - Phone:440-460-8000
Practice Address - Fax:440-460-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical