| Cleveland Department Of Public Health, J. Glen Smith Treatment Program | |
|
11100 Saint Clair Ave J. Glen Smith Health Center Cleveland OH 44108-1943 | |
| (216) 664-3891 | |
| Not Available |
| Full Name | Cleveland Department Of Public Health, J. Glen Smith Treatment Program |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 11100 Saint Clair Ave, Cleveland, Ohio |
| Authorized Official Name and Position | Matt Carroll (DIRECTOR, CDPH) |
| Authorized Official Contact | 2166646790 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cleveland Department Of Public Health, J. Glen Smith Treatment Program 1925 Saint Clair Ave Ne Cleveland Department Of Public Health Cleveland OH 44114-2028 Ph: (216) 664-3920 | Cleveland Department Of Public Health, J. Glen Smith Treatment Program 11100 Saint Clair Ave J. Glen Smith Health Center Cleveland OH 44108-1943 Ph: (216) 664-3891 |
| NPI Number | 1740345339 |
|---|---|
| Provider Enumeration Date | 12/26/2006 |
| Last Update Date | 10/16/2008 |
| Medicare PECOS PAC ID | 2264346030 |
|---|---|
| Medicare Enrollment ID | O20180307002843 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740345339 | NPI | - | NPPES |
| 1073 | Other | OH | ODADAS PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1073 (Ohio) | Primary |
| Provider Name | Ann K Avery |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1972528719 PECOS PAC ID: 3274509849 Enrollment ID: I20040903001031 |
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