1326159401 NPI number — INTEGRATED HEALTH SERVICES MANAGEMENT INC

Table of content: (NPI 1326159401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326159401 NPI number — INTEGRATED HEALTH SERVICES MANAGEMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED HEALTH SERVICES MANAGEMENT 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:
1326159401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17900 JEFFERSON PARK RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44130-3437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-274-5035
Provider Business Mailing Address Fax Number:
440-260-6153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21625 CHAGRIN BLVD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-5363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-283-2123
Provider Business Practice Location Address Fax Number:
216-283-2126
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AHMED
Authorized Official First Name:
MANSOOR
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
440-239-7533

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  35-064007 , 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)

  • Identifier: 000000121632 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4316806 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 69713 . This is a "QUALCHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".