Basic Information
| Provider Information | |||||||||
| NPI: | 1194777292 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESCURO | ||||||||
| FirstName: | RUBEN | ||||||||
| MiddleName: | SALES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ESCURO | ||||||||
| OtherFirstName: | RUBEN | ||||||||
| OtherMiddleName: | S | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 41201 SCHADDEN ROAD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | ELYRIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440352220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403240401 | ||||||||
| FaxNumber: | 4403240405 | ||||||||
| Practice Location | |||||||||
| Address1: | 41201 SCHADDEN ROAD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | ELYRIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440352220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403240401 | ||||||||
| FaxNumber: | 4403240405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 05/09/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 53202 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 341832420033 | 01 | OH | CARESOURCE | OTHER | E53202 | 01 | OH | SUMMACARE | OTHER | 0688868 | 05 | OH | MEDICAID | CC6352 | 01 | OH | RAILROAD MEDICARE | OTHER | 830002970 | 01 | OH | RAILROAD MEDICARE | OTHER | 000000139924 | 01 | OH | ANTHEM | OTHER | 30000941 | 01 | OH | UNITED HEALTHCARE | OTHER |