Healthcare Provider Details

I. General information

NPI: 1871202481
Provider Name (Legal Business Name): ST VINCENT CHARITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 E 22ND ST
CLEVELAND OH
44115-3111
US

IV. Provider business mailing address

2351 E 22ND ST
CLEVELAND OH
44115-3111
US

V. Phone/Fax

Practice location:
  • Phone: 216-363-2691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY RAUH
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 216-363-3000