Provider Demographics
NPI:1720071467
Name:SURACE, STEVEN A (CRNA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:A
Last Name:SURACE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH182770367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2305286Medicaid
OH732312OtherBUCKEYE MEDICAID
OHP00438139OtherRAILROAD MEDICARE
OH5254487OtherAETNA
OH000000224757OtherUNISON
OH000000516014OtherANTHEM
OH0583328OtherBCMH
OH414825OtherWELLCARE MEDICAID
OH732312OtherBUCKEYE MEDICAID
OHSU8229672Medicare PIN