Provider Demographics
NPI:1891793915
Name:NORTHEAST OHIO SURGERY CENTER, LLC
Entity type:Organization
Organization Name:NORTHEAST OHIO SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:B
Authorized Official - Last Name:YOKIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-360-9610
Mailing Address - Street 1:3755 ORANGE PLACE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORANGE VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4455
Mailing Address - Country:US
Mailing Address - Phone:216-360-9610
Mailing Address - Fax:216-360-9606
Practice Address - Street 1:3755 ORANGE PLACE
Practice Address - Street 2:SUITE 102
Practice Address - City:ORANGE VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44122-4455
Practice Address - Country:US
Practice Address - Phone:216-360-9610
Practice Address - Fax:216-360-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0673AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000227520OtherBLUE CROSS/BLUE SHIELD
OH490005606OtherMEDICARE RAILROAD
OH2391737Medicaid
OH352498400OtherOHIO DEPT OF LABOR
OH=========00OtherOHIO BWC
OH000000227520OtherBLUE CROSS/BLUE SHIELD
OH352498400OtherOHIO DEPT OF LABOR
OHNO3611631Medicare PIN