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6835 Broadway Ave Cleveland OH 44105-1313 | |
| (216) 957-1850 | |
| (216) 957-1695 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 6835 Broadway Ave, Cleveland, Ohio |
| Authorized Official Name and Position | Derrick Hollings (EVP/CFO) |
| Authorized Official Contact | 2167787800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2500 Metrohealth Dr Cleveland OH 44109-1900 Ph: (216) 778-7800 | 6835 Broadway Ave Cleveland OH 44105-1313 Ph: (216) 957-1850 |
| NPI Number | 1346919362 |
|---|---|
| Provider Enumeration Date | 09/13/2021 |
| Last Update Date | 05/09/2024 |
| Medicare PECOS PAC ID | 8628982949 |
|---|---|
| Medicare Enrollment ID | O20220208001185 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346919362 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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