Basic Information
| Provider Information | |||||||||
| NPI: | 1568796506 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT CARMEL HEALTH PROVIDERS TWO LLC | ||||||||
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| OtherOrganizationName: | MOUNT CARMEL NEUROLOGY PROVIDERS AT GRANVILLE | ||||||||
| 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: | 2000 NEWARK GRANVILLE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | GRANVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430237009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148822581 | ||||||||
| FaxNumber: | 6148826097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2009 | ||||||||
| LastUpdateDate: | 09/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | FOWLER | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | IMPLEMENTATION SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 6145464956 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.