1396746921 NPI number — CLEVELAND EAR NOSE THROAT AND ALLERGY CENTER INC

Table of content: (NPI 1396746921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396746921 NPI number — CLEVELAND EAR NOSE THROAT AND ALLERGY CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEVELAND EAR NOSE THROAT AND ALLERGY CENTER 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:
1396746921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 72591
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:
44192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-662-3711
Provider Business Mailing Address Fax Number:
216-662-5139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 TRANSPORTATION BLVD
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
GARFIELD HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44125-5324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-662-3711
Provider Business Practice Location Address Fax Number:
216-662-5139
Provider Enumeration Date:
08/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
BERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, CLEVELAND EAR NOSE THROA
Authorized Official Telephone Number:
216-662-3711

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , 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: 2149419 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH5776 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2149384 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0828886 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2145780 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0675612 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0115619 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2149400 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0419292 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0600415 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0711073 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2149393 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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