Organization · NPI-2

Physicians Provider Services,inc

Preferred Provider Organization · Cleveland, OH

NPI number1609053107

StatusActive

Last updated in NPPESSep 26, 2008

Details

NPI: 1609053107
Entity type: Organization (NPI-2)
Legal business name: Physicians Provider Services,inc
Organization subpart: No
Enumeration date: Jan 28, 2008
Last updated: Sep 26, 2008

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
305R00000X	Preferred Provider Organization	35041190J	OH	Yes

Practice location

16603 Harvard Ave
Cleveland, OH 44128-2203

Phone 216-921-5222 · Fax 216-921-6421

Mailing address

16603 Harvard Ave
Cleveland, OH 44128-2203

Phone 216-921-5222 · Fax 216-921-6421

Authorized official

Andrew Jimerson
Physician
2169215222

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