Provider Demographics
NPI:1366761397
Name:MEDINA-SUMMIT AMBULATORY SURGERY CENTER
Entity type:Organization
Organization Name:MEDINA-SUMMIT AMBULATORY SURGERY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MESHEKOW
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:330-309-5415
Mailing Address - Street 1:3780 MEDINA RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5947
Mailing Address - Country:US
Mailing Address - Phone:330-952-0014
Mailing Address - Fax:330-952-0015
Practice Address - Street 1:3780 MEDINA RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5947
Practice Address - Country:US
Practice Address - Phone:330-952-0014
Practice Address - Fax:330-952-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3612631Medicare PIN