Provider Demographics
NPI:1396077582
Name:HILLTOP AMBULATORY SURGERY CENTER LLC
Entity type:Organization
Organization Name:HILLTOP AMBULATORY SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-449-8880
Mailing Address - Street 1:5035 MAYFIELD RD
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2688
Mailing Address - Country:US
Mailing Address - Phone:216-923-0666
Mailing Address - Fax:216-432-1136
Practice Address - Street 1:5035 MAYFIELD RD
Practice Address - Street 2:SUIITE # 100
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2688
Practice Address - Country:US
Practice Address - Phone:216-923-0666
Practice Address - Fax:216-432-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0965AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0062559Medicaid