Basic Information
| Provider Information | |||||||||
| NPI: | 1255787867 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE METROHEALTH SYSTEM | ||||||||
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| OtherOrganizationName: | METROHEALTH SYSTEM PARMA AMBULATORY SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 METROHEALTH DR | ||||||||
| Address2: | ATTN: LINDA GREENHILL, PFS SPVR OLD BROOKLYN CAMPUS | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441091900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169572442 | ||||||||
| FaxNumber: | 2169572148 | ||||||||
| Practice Location | |||||||||
| Address1: | 12301 SNOW RD | ||||||||
| Address2: | METROHEALTH SYSTEM PARMA AMBULATORY SURGICAL CENTER | ||||||||
| City: | PARMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441301002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165247377 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2016 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | HIMES | ||||||||
| AuthorizedOfficialFirstName: | GEOFF | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2169572799 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE METROHEALTH SYSTEM | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.