WILLOUGHBY ASC LLC; NPI #1245202472

Contact Information

WILLOUGHBY ASC LLC

34940 RIDGE RD
SUITE B
WILLOUGHBY, OH 44094-4196

Phone: 440-953-8568
Fax: 440-953-4429
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Ambulatory Surgical	261QA1903X	49	Ambulatory Surgical Center

Indicates primary specialty

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NPI Profile & details for WILLOUGHBY ASC LLC

NPI Number 1245202472

LBN Legal business name WILLOUGHBY ASC LLC

Authorized official PHILLIP CLENDENIN - (PRESIDENT)

Entity Organization

Organization subpart ¹ No

Enumeration date 02/02/2006

Last updated 09/07/2023 - About 3 years ago

Identifiers

OH	License #	0389AS
OH	Medicaid	2039645

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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