NPIMap

Organization Active NPI

Crystal Clinic Surgery Center, Inc.

  • Ambulatory Surgical Clinic/Center
  • Akron, OH
National Provider Identifier
1104818038
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
0102AS-153 Issued in OH
Legal business name
CRYSTAL CLINIC SURGERY CENTER, INC.
Practice address
3975 Embassy Pkwy
Suite 202
Akron, OH 44333-8320
Phone
(330) 668-4085
Fax
(330) 668-2624
NPI assigned
Aug 17, 2005
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joanne Stone, RN,BSN
Title
Administrator
Phone
(330) 668-4085

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 0102AS-153 OH Primary

Addresses

Primary practice location

3975 Embassy Pkwy
Suite 202
Akron, OH 44333-8320

Mailing address

3975 Embassy Pkwy
Suite 202
Akron, OH 44333-8320
Phone (330) 668-4085

Other identifiers 3

IdentifierTypeStateIssuer
100773OtherOHKAISER PROVIDER NO.
68-00067OtherOHUNITED HEALTHCARE PROV NO
157362OtherOHANTHEM PROVIDER NO.

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1104818038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3975 EMBASSY PKWY",
            "address_2": "SUITE 202",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443338320",
            "telephone_number": "330-668-4085",
            "fax_number": "330-668-2624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3975 EMBASSY PKWY",
            "address_2": "SUITE 202",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443338320",
            "telephone_number": "330-668-4085",
            "fax_number": "330-668-2624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL CLINIC SURGERY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-17",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "STONE",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "330-668-4085",
        "authorized_official_credential": "RN,BSN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OH",
            "license": "0102AS-153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER PROVIDER NO.",
            "identifier": "100773",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE PROV NO",
            "identifier": "68-00067",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NO.",
            "identifier": "157362",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Akron, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.