1780963843 NPI number — CLEVELAND EAR NOSE THROAT, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780963843 NPI number — CLEVELAND EAR NOSE THROAT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEVELAND EAR NOSE THROAT, 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:
1780963843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6770 MAYFIELD RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
MAYFIELD HTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44124-2299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-461-0150
Provider Business Mailing Address Fax Number:
440-461-8221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6770 MAYFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
MAYFIELD HTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44124-2299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-461-0150
Provider Business Practice Location Address Fax Number:
440-461-8221
Provider Enumeration Date:
08/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
BERT
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
440-461-0150

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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