| Florence Kimbo M.d., Llc | |
|
18660 Bagley Rd Bldg 1 Suite 404 Cleveland OH 44130-3483 | |
| (440) 234-8746 | |
| Not Available |
| Full Name | Florence Kimbo M.d., Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 18660 Bagley Rd Bldg 1, Cleveland, Ohio |
| Authorized Official Name and Position | Florence V Kimbo (SOLE OWNER) |
| Authorized Official Contact | 4402348746 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Florence Kimbo M.d., Llc 18660 Bagley Rd Bldg 1 Suite 404 Cleveland OH 44130-3483 Ph: (440) 234-8746 | Florence Kimbo M.d., Llc 18660 Bagley Rd Bldg 1 Suite 404 Cleveland OH 44130-3483 Ph: (440) 234-8746 |
| NPI Number | 1457788960 |
|---|---|
| Provider Enumeration Date | 09/28/2013 |
| Last Update Date | 02/26/2016 |
| Medicare PECOS PAC ID | 4183850423 |
|---|---|
| Medicare Enrollment ID | O20131115000667 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457788960 | NPI | - | NPPES |
| 0092217 | Medicaid | OH |
| Provider Name | Florence Vidzem Kimbo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851475875 PECOS PAC ID: 6204876881 Enrollment ID: I20050504000128 |
| Provider Name | Anthony Shumway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982836425 PECOS PAC ID: 8628103199 Enrollment ID: I20100323000422 |
| Provider Name | Kuldeep Vaghela |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255544037 PECOS PAC ID: 5092857367 Enrollment ID: I20111209000435 |
| Provider Name | Dawn Dunaway |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1972845188 PECOS PAC ID: 8123244779 Enrollment ID: I20140717000825 |
| Provider Name | Christopher M Mccourt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376994475 PECOS PAC ID: 5395033955 Enrollment ID: I20161013002220 |
| Provider Name | Andrea Soares |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831390244 PECOS PAC ID: 6204110158 Enrollment ID: I20170221002395 |
| Provider Name | Stephen R Pessefall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730413956 PECOS PAC ID: 1254604465 Enrollment ID: I20170911002054 |
| Provider Name | Saissy E Kendig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811418619 PECOS PAC ID: 8123393246 Enrollment ID: I20170928004166 |
| Provider Name | James R. Pontau |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992243851 PECOS PAC ID: 9234494097 Enrollment ID: I20180525001062 |
| Provider Name | Amy Justice |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609447499 PECOS PAC ID: 2668875881 Enrollment ID: I20210726003644 |
| Provider Name | Austin Brooks Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619574639 PECOS PAC ID: 7719369727 Enrollment ID: I20220806000329 |
| Provider Name | Julie M Goch |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376814970 PECOS PAC ID: 7012245558 Enrollment ID: I20240325001842 |
| Provider Name | Melissa Leonhardt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629327689 PECOS PAC ID: 9739526732 Enrollment ID: I20240326003854 |
| Provider Name | Marlon L Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154873685 PECOS PAC ID: 3274970066 Enrollment ID: I20240328003074 |
| Provider Name | Jennifer T Mewhinney |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235554825 PECOS PAC ID: 0749628303 Enrollment ID: I20240402003783 |
| Provider Name | Jodie Vansach |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134162647 PECOS PAC ID: 5092156190 Enrollment ID: I20240507002010 |
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