Basic Information
| Provider Information | |||||||||
| NPI: | 1184859944 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT CARMEL HEALTH PROVIDERS TWO, LLC | ||||||||
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| OtherOrganizationName: | VASCULAR AND ENDOVASCULAR SURGICAL PROVIDERS (LONDON) | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 951144 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441930005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145464400 | ||||||||
| FaxNumber: | 6145464441 | ||||||||
| Practice Location | |||||||||
| Address1: | 117 W HIGH ST | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431401300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142211009 | ||||||||
| FaxNumber: | 6142210728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2009 | ||||||||
| LastUpdateDate: | 05/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | MOYER | ||||||||
| AuthorizedOfficialFirstName: | BRITTANY | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | IMPLEMENATION SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 6145464672 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.