1083637912 NPI number — ST VINCENT CHARITY MEDICAL CENTER

Table of content: (NPI 1083637912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083637912 NPI number — ST VINCENT CHARITY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST VINCENT CHARITY MEDICAL CENTER
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:
ST VINCENT CHARITY MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1083637912
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/16/2008
NPI Reactivation Date:
08/17/2012

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6935 TREELINE DR STE J
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRECKSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44141-3393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-746-3401
Provider Business Mailing Address Fax Number:
440-746-3405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2351 E 22ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44115-3111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-861-6200
Provider Business Practice Location Address Fax Number:
440-746-3405
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUSNACZYK
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VP SCHS/CFO
Authorized Official Telephone Number:
216-436-4653

Provider Taxonomy Codes

  • Taxonomy code: 276400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0818 . This is a "MACSIS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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