1588844302 NPI number — PATRICK D. ENDERS, M.D., L.L.C.

Table of content: (NPI 1588844302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588844302 NPI number — PATRICK D. ENDERS, M.D., L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICK D. ENDERS, M.D., L.L.C.
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:
1588844302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6009 LANDERHAVEN DR
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
MAYFIELD HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44124-4192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-461-0042
Provider Business Mailing Address Fax Number:
440-461-5033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6009 LANDERHAVEN DR
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
MAYFIELD HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44124-4192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-461-0042
Provider Business Practice Location Address Fax Number:
440-461-5033
Provider Enumeration Date:
11/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ENDERS
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-461-0042

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  35039953 , 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: 0321842 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: A75798 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000122911 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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