Provider Demographics
NPI:1700815552
Name:SURGCENTER HUDSON, LLC
Entity Type:Organization
Organization Name:SURGCENTER HUDSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALID
Authorized Official - Middle Name:G
Authorized Official - Last Name:LABABIDI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:330-208-2720
Mailing Address - Street 1:2215 E WATERLOO RD
Mailing Address - Street 2:STE 313
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-3856
Mailing Address - Country:US
Mailing Address - Phone:330-208-2720
Mailing Address - Fax:330-208-2721
Practice Address - Street 1:5700 DARROW RD
Practice Address - Street 2:STE 109
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-5021
Practice Address - Country:US
Practice Address - Phone:330-208-2720
Practice Address - Fax:330-208-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0781AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2655201Medicaid
OH2655201Medicaid
OH2655201Medicaid
OH=========00OtherBWC