Healthcare Provider Details

I. General information

NPI: 1346009586
Provider Name (Legal Business Name): MR. ALGENON PUGH JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20341 BALL AVE
EUCLID OH
44123-2723
US

IV. Provider business mailing address

20341 BALL AVE
EUCLID OH
44123-2723
US

V. Phone/Fax

Practice location:
  • Phone: 216-320-7410
  • Fax:
Mailing address:
  • Phone: 216-320-7410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: