1437300910 NPI number — ST. ELIZABETH CARDIAC CATH LAB, LLC

Table of content: BRIAN KEITH LELAND P.A. (NPI 1851559967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437300910 NPI number — ST. ELIZABETH CARDIAC CATH LAB, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. ELIZABETH CARDIAC CATH LAB, LLC
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:
1437300910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 537
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44501-0537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-480-3998
Provider Business Mailing Address Fax Number:
330-480-3498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1044 BELMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44504-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-480-3998
Provider Business Practice Location Address Fax Number:
330-480-3498
Provider Enumeration Date:
10/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RIZER
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
330-480-3797

Provider Taxonomy Codes

  • Taxonomy code: 246W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2459692 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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