1710946785 NPI number — LAKE COUNTY AND WEST EKG ASSOCIATES

Table of content: (NPI 1710946785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710946785 NPI number — LAKE COUNTY AND WEST EKG ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKE COUNTY AND WEST EKG ASSOCIATES
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:
1710946785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30701 LORAIN RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH OLMSTED
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44070-6325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-274-5000
Provider Business Mailing Address Fax Number:
440-716-8608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 AUBURN RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PAINESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44077-9602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-352-2754
Provider Business Practice Location Address Fax Number:
440-352-0330
Provider Enumeration Date:
03/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BANNA
Authorized Official First Name:
M
Authorized Official Middle Name:
AHMAD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-358-5555

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0813794 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18958 . This is a "QUALCHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2597481 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: CK1332 . This is a "RAILROAD MEDICARE B" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 264168 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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