N/A
Preferred Provider Organization in Cleveland, OH. Organization (NPI-2).
NPI number1932513694
StatusActive
Last updated in NPPESJun 19, 2014
Details
- NPI
- 1932513694
- Entity type
- Organization (NPI-2)
- Legal business name
- N/A
- Organization subpart
- No
- Enumeration date
- Jun 19, 2014
- Last updated
- Jun 19, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 305R00000X | Preferred Provider Organization | 401616630214 | OH | Yes |
Practice location
8722 Beckman AveCleveland, OH 44104-2337
Phone 216-937-9110
Mailing address
8722 Beckman AveCleveland, OH 44104-2337
Phone 216-937-9110
Authorized official
Christina Yvette Blake
Stna
2169379110
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