MEDICARE: DR. PAMELA JEAN HRUBY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	35079762H	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000564656	OTHER	OH	ANTHEM BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000564033	OTHER	OH	ANTHEM BLUE SHIELD
4	T79762	OTHER	OH	SUMMACARE

General Provider Information

NPI Number	:	1043284920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA JEAN HRUBY MD

Provider Business Mailing Address
First Line	:	12000 MCCRACKEN RD
Second Line	:	SUITE 450
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-2964
Country	:	US
Telephone Number	:	216-663-7355
Fax Number	:	216-663-7193

Provider Business Practice Location Address
First Line	:	12000 MCCRACKEN RD
Second Line	:	SUITE 450
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-2964
Country	:	US
Telephone Number	:	216-663-7355
Fax Number	:	216-663-7193

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	10/26/2011

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