Basic Information
| Provider Information | |||||||||
| NPI: | 1093800666 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT CARMEL HEALTH PROVIDERS TWO, LLC | ||||||||
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| OtherOrganizationName: | MOUNT CARMEL NEUROSCIENCES (NEUROSURGERY) | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 951144 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145464400 | ||||||||
| FaxNumber: | 6145464441 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 MOUNT CARMEL MALL | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142211009 | ||||||||
| FaxNumber: | 6142210728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 12/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | MOYER | ||||||||
| AuthorizedOfficialFirstName: | BRITTANY | ||||||||
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| AuthorizedOfficialTitleorPosition: | IMPLEMENTATION SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 6145464672 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MOUNT CARMEL HEALTH PROVIDERS TWO, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.