1265621171 NPI number — RONALD GOLOVAN, M.D., INC.

Table of content: (NPI 1265621171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265621171 NPI number — RONALD GOLOVAN, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD GOLOVAN, M.D., 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:
1265621171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1730 W 25TH ST STE 2E
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:
44113-3108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-696-2205
Provider Business Mailing Address Fax Number:
216-363-2058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1730 W 25TH ST STE 2E
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:
44113-3108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-696-2205
Provider Business Practice Location Address Fax Number:
216-363-2058
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOLOVAN
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
216-696-2205

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35060871 , 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: 0858611 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: F60871 . This is a "SUMMACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000187185 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0402830 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110213818 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351284 . This is a "WELLCARE OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 302482804007 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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