1215234976 NPI number — CLINIC MEDICAL SERVICES COMPANY

Table of content: MRS. KELLEY LYNN BARNEY CRNA (NPI 1922212927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215234976 NPI number — CLINIC MEDICAL SERVICES COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINIC MEDICAL SERVICES COMPANY
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:
6
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:
1215234976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6100 W CREEK RD STE 35
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44131-2133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-642-8165
Provider Business Mailing Address Fax Number:
216-642-1064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1449 BOARDMAN CANFIELD RD STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOARDMAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44512-8070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-965-7370
Provider Business Practice Location Address Fax Number:
330-965-7377
Provider Enumeration Date:
02/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KAFITI
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, BUSINESS OPERATIONS
Authorized Official Telephone Number:
216-445-5023

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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