Organization
CRYSTAL CLINIC SURGERY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANNE STONE RN,BSN (ADMINISTRATOR)
(330) 668-4085
Entity
Organization
Contact information
Practice address
3975 EMBASSY PKWY, SUITE 202, AKRON, OH 44333-8320
(330) 668-4085
(330) 668-2624
Mailing address
3975 EMBASSY PKWY, SUITE 202, AKRON, OH 44333-8320
(330) 668-4085
(330) 668-2624
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0102AS-153
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100773
KAISER PROVIDER NO.
OH
01
—
157362
ANTHEM PROVIDER NO.
OH
01
—
68-00067
UNITED HEALTHCARE PROV NO
OH
Enumeration date
08/17/2005
Last updated
04/20/2008
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