Willoughby ASC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0389AS Issued in OH

Legal business name

WILLOUGHBY ASC LLC

Practice address

34940 Ridge Rd
Suite B
Willoughby, OH 44094-4196

Phone

(440) 953-8568

Fax

(440) 953-4429

NPI assigned

Feb 2, 2006

Organization subpart

No

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

Authorized official

Name

Phillip A. Clendenin

Title

President

Phone

(615) 665-1283

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CDH Endoscopy Center Doing business as

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1245202472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34940 RIDGE RD",
            "address_2": "SUITE B",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944196",
            "telephone_number": "440-953-8568",
            "fax_number": "440-953-4429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34940 RIDGE RD",
            "address_2": "SUITE B",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944196",
            "telephone_number": "440-953-8568",
            "fax_number": "440-953-4429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOUGHBY ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-02",
        "last_updated": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "CLENDENIN",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-665-1283"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OH",
            "license": "0389AS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2039645",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CDH Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Denise Ann Williams, MEDICAL ASSISTANT
• Kalona Williams
• Kourtney Williams
• Sarah Williams
• Willoughby Al Operations, LLC
• Willoughby Chiropractic Center, Inc.
• Willoughby SNF Healthcare LLC
• Willoughby Surgery Center, LLC
• Willoughby Therapy Inc
• Willoughby-Eastlake City SD

• Ambulatory Surgical Clinic/Center in Willoughby, OH
• Providers in Willoughby, OH by specialty
• Ambulatory Surgical Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; 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.