Organization
SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BARBARA DRAVES (ADMINISTRATOR)
(440) 826-3240
Entity
Organization
Contact information
Practice address
19250 BAGLEY RD, CLEVELAND, OH 44130-3314
(440) 826-3240
(440) 816-0273
Mailing address
19250 BAGLEY RD, CLEVELAND, OH 44130-3314
(440) 826-3240
(440) 816-0273
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0041AS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000157345
ANTHEM
OH
05
—
0584318
—
OH
01
—
1411062
UNITED MINEWORKERS
OH
01
—
6800051
UNITED HEALTHCARE
OH
Enumeration date
07/05/2005
Last updated
09/27/2010
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