Organization
MENTOR SURGERY CENTER LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS TRACY ANN PETERS CPC (BUSINESS OFFICE MANAGER)
(440) 205-5467
Entity
Organization
Contact information
Practice address
9485 MENTOR AVE, STE 1, MENTOR, OH 44060-4597
(440) 205-5454
(440) 205-5402
Mailing address
9485 MENTOR AVE, STE 1, MENTOR, OH 44060-8711
(440) 205-5454
(440) 205-5402
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0404AS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2106143
—
OH
Enumeration date
08/09/2005
Last updated
12/31/2014
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