1174703227 NPI number — SOUTHWEST PULMONARY ASSOCIATES INC

Table of content: (NPI 1174703227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174703227 NPI number — SOUTHWEST PULMONARY ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST PULMONARY ASSOCIATES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174703227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 RIDGE RD
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
PARMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44129-2394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-884-7272
Provider Business Mailing Address Fax Number:
440-884-7972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7550 LUCERNE DR
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44130-6588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-556-6236
Provider Business Practice Location Address Fax Number:
440-234-3313
Provider Enumeration Date:
11/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CLARY
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
440-884-7272

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  35050093 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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