| Med Management Indiana Pc | |
|
5300 Marymount Village Dr Garfield Heights OH 44125-2974 | |
| (888) 365-6271 | |
| Not Available |
| Full Name | Med Management Indiana Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5300 Marymount Village Dr, Garfield Heights, Ohio |
| Authorized Official Name and Position | Riaz Rahman (DIRECTOR & SHAREHOLDER) |
| Authorized Official Contact | 3214439924 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Med Management Indiana Pc 7272 Wurzbach Rd Ste 601 San Antonio TX 78240-4803 Ph: (210) 615-3483 | Med Management Indiana Pc 5300 Marymount Village Dr Garfield Heights OH 44125-2974 Ph: (888) 365-6271 |
| NPI Number | 1225519333 |
|---|---|
| Provider Enumeration Date | 08/27/2018 |
| Last Update Date | 10/10/2024 |
| Certification Date | 10/10/2024 |
| Medicare PECOS PAC ID | 5698027266 |
|---|---|
| Medicare Enrollment ID | O20181009002497 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225519333 | NPI | - | NPPES |
| 01076161A | Other | IN | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Kelly L Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003228446 PECOS PAC ID: 4385867787 Enrollment ID: I20140603000350 |
| Provider Name | Riaz Rahman |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1275630717 PECOS PAC ID: 8729077235 Enrollment ID: I20181009002677 |
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