1144219601 NPI number — JOHN J CAHILL PA-C

Table of content: JOHN J CAHILL PA-C (NPI 1144219601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144219601 NPI number — JOHN J CAHILL PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAHILL
Provider First Name:
JOHN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

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:
1144219601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37407 PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLOUGHBY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44094-6050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-951-6038
Provider Business Mailing Address Fax Number:
440-449-1101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6770 MAYFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 348
Provider Business Practice Location Address City Name:
MAYFIELD HTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44124-2299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-449-1101
Provider Business Practice Location Address Fax Number:
440-449-7715
Provider Enumeration Date:
10/18/2005

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: 363A00000X , with the licence number:  50-000293 , 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: 000000336116 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00195664 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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