Healthcare Provider Details

I. General information

NPI: 1053415612
Provider Name (Legal Business Name): OHIO CHEST PHYSICIANS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15805 PURITAS AVE
CLEVELAND OH
44135-2611
US

IV. Provider business mailing address

PO BOX 932085
CLEVELAND OH
44194-0007
US

V. Phone/Fax

Practice location:
  • Phone: 216-267-5933
  • Fax: 216-267-5133
Mailing address:
  • Phone: 330-400-5437
  • Fax: 330-546-7758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: PATRICIA VOLLE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 216-267-5139