Healthcare Provider Details

I. General information

NPI: 1477275485
Provider Name (Legal Business Name): SCT PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W ROOSEVELT RD
BROADVIEW IL
60155-3957
US

IV. Provider business mailing address

6993 PEARL RD
CLEVELAND OH
44130-7831
US

V. Phone/Fax

Practice location:
  • Phone: 216-398-0349
  • Fax:
Mailing address:
  • Phone: 216-398-0349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER ORR
Title or Position: CHIEF MEDICAL OFFICER
Credential: PA-C
Phone: 216-398-0349