1922292093 NPI number — DR. BASMA RICAURTE MD

Table of content: DR. BASMA RICAURTE MD (NPI 1922292093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922292093 NPI number — DR. BASMA RICAURTE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICAURTE
Provider First Name:
BASMA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1922292093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15805 PURITAS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44135-2611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-267-5139
Provider Business Mailing Address Fax Number:
216-267-5133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29099 HEALTH CAMPUS DR STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTLAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44145-5255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-835-6163
Provider Business Practice Location Address Fax Number:
440-871-9408
Provider Enumeration Date:
08/31/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  35089919 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: 35089919 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 35.089919 , 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: 2954567 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".