Organization · NPI-2

Admiral Medical Management Group LLC

Clinic/Center, Multi-Specialty · Cleveland, OH

NPI number1407357742
StatusActive
Last updated in NPPESSep 17, 2024

Details

NPI
1407357742
Entity type
Organization (NPI-2)
Legal business name
Admiral Medical Management Group LLC
Organization subpart
No
Enumeration date
Feb 22, 2018
Certification date
Sep 17, 2024
Last updated
Sep 17, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM1300X Clinic/Center, Multi-Specialty–OHYes
163WA2000X Registered Nurse, Administrator366986OH
261Q00000X Clinic/Center–OH
261QP2300X Clinic/Center, Primary Care–OH

Practice location

11201 Shaker Blvd Unit 201
Cleveland, OH 44104-3869

Phone 216-855-7775

Mailing address

11201 Shaker Blvd Unit 201
Cleveland, OH 44104-3869

Phone 216-855-7775

Authorized official

Ketura Jackson
Aprn Cnp
2168557775

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