Healthcare Provider Details

I. General information

NPI: 1780845685
Provider Name (Legal Business Name): GENEVA/MADISON SLEEP CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13221 RAVENNA RD STE 13
CHARDON OH
44024-9016
US

IV. Provider business mailing address

21 W MAIN ST
MADISON OH
44057-3125
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-9598
  • Fax:
Mailing address:
  • Phone: 440-285-9598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35040889-D
License Number StateOH

VIII. Authorized Official

Name: DR. ANTHONY F DIMARCO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 440-285-9598