| Proud To Be, Inc | |
|
11811 Shaker Blvd Ste 123 Cleveland OH 44120-1927 | |
| (216) 374-7682 | |
| (216) 455-5436 |
| Full Name | Proud To Be, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11811 Shaker Blvd Ste 123, Cleveland, Ohio |
| Authorized Official Name and Position | Tiffany Martin Thornton (CEO) |
| Authorized Official Contact | 2163747682 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Proud To Be, Inc 4812 Lindsey Ln Richmond Hts OH 44143-2928 Ph: (216) 374-7682 | Proud To Be, Inc 11811 Shaker Blvd Ste 123 Cleveland OH 44120-1927 Ph: (216) 374-7682 |
| NPI Number | 1376050542 |
|---|---|
| Provider Enumeration Date | 01/09/2018 |
| Last Update Date | 03/15/2018 |
| Medicare PECOS PAC ID | 5698037117 |
|---|---|
| Medicare Enrollment ID | O20180321002395 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376050542 | NPI | - | NPPES |
| Provider Name | Tiffany Martin-thornton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902268691 PECOS PAC ID: 2668766841 Enrollment ID: I20160810002606 |
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