Basic Information
| Provider Information | |||||||||
| NPI: | 1528203981 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT CARMEL HEALTHPROVIDERS TWO LLC | ||||||||
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| OtherOrganizationName: | MOUNT CARMEL BREAST SURGERY AT WEST | ||||||||
| 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: | 750 MOUNT CARMEL MALL | ||||||||
| Address2: | 230 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432221553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142242281 | ||||||||
| FaxNumber: | 6142218869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2008 | ||||||||
| LastUpdateDate: | 04/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | MOYER | ||||||||
| AuthorizedOfficialFirstName: | BRITTANY | ||||||||
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| AuthorizedOfficialTitleorPosition: | IMPLEMENTATION SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 6145464672 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.