Organization
PREMIUM SURGERY CENTER LLC
Active
Other names
Mercy Premium Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROSE M BEE (TITLE ADMIN)
(440) 937-5851
Entity
Organization
Contact information
Practice address
5319 HOAG DR, ELYRIA, OH 44035
(440) 930-6042
(440) 930-6105
Mailing address
5319 HOAG DR, ELYRIA, OH 44035
(440) 930-6042
(440) 930-6105
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0572AS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000338767
BLUE CROSS BLUE SHIELD
—
05
—
2213107
—
OH
01
—
P00124229
RR MEDICARE
—
Enumeration date
03/16/2006
Last updated
04/18/2019
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