| Maxillofacial Surgery Innovative Services | |
|
1284 Som Center Rd Ste 219 Mayfield Heights OH 44124-2048 | |
| (888) 774-7773 | |
| (888) 774-7970 |
| Full Name | Maxillofacial Surgery Innovative Services |
|---|---|
| Speciality | Clinic/center |
| Location | 1284 Som Center Rd Ste 219, Mayfield Heights, Ohio |
| Authorized Official Name and Position | Michelle Ann Hancock (CREDENTIALING DIRECTOR) |
| Authorized Official Contact | 5153216451 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maxillofacial Surgery Innovative Services 1284 Som Center Rd Ste 219 Mayfield Heights OH 44124-2048 Ph: (888) 774-7773 | Maxillofacial Surgery Innovative Services 1284 Som Center Rd Ste 219 Mayfield Heights OH 44124-2048 Ph: (888) 774-7773 |
| NPI Number | 1962929240 |
|---|---|
| Provider Enumeration Date | 08/28/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962929240 | NPI | - | NPPES |
| 2855503 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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