Healthcare Provider Details

I. General information

NPI: 1871742130
Provider Name (Legal Business Name): LOUIS STOKES VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

34426 PUTH DR
AVON OH
44011-1916
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax:
Mailing address:
  • Phone: 440-396-5461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number59.000233
License Number StateOH

VIII. Authorized Official

Name: SUSAN PETRAK
Title or Position: MANAGEMENT AND PROGRAM ANALYST
Credential:
Phone: 216-791-3800