Basic Information
| Provider Information | |||||||||
| NPI: | 1659324705 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOUNDATION SURGERY AFFILIATE OF MIDDLEBURG HEIGHTS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BIG CREEK SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14000 N PORTLAND AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731344003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056081766 | ||||||||
| FaxNumber: | 4056081866 | ||||||||
| Practice Location | |||||||||
| Address1: | 15345 BAGLEY RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441304825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407438400 | ||||||||
| FaxNumber: | 4407438401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 03/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | NEWMAN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP AND CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4056081706 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 0782AS | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.