Organization
SURGERY CENTER OF CANFIELD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENETHA D MORAN (AUTHORIZED OFFICIAL)
(972) 763-3893
Entity
Organization
Contact information
Practice address
4147 WESTFORD DR, CANFIELD, OH 44406-8086
(330) 702-1489
(330) 702-1545
Mailing address
4147 WESTFORD DR, CANFIELD, OH 44406-8086
(330) 702-1489
(330) 702-1545
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0734AS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2522434
—
OH
01
—
SU3611911
RAILROAD MEDICARE
OH
Enumeration date
10/17/2005
Last updated
10/11/2017
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