Healthcare Provider Details

I. General information

NPI: 1467488924
Provider Name (Legal Business Name): COMMUNITY HOSPITALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18697 BAGLEY RD
MIDDLEBURG HEIGHTS OH
44130-3417
US

IV. Provider business mailing address

30680 BAINBRIDGE RD
SOLON OH
44139-2282
US

V. Phone/Fax

Practice location:
  • Phone: 440-816-8000
  • Fax:
Mailing address:
  • Phone: 440-542-5023
  • Fax: 440-542-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE MORRISON
Title or Position: VICE-PRESIDENT
Credential:
Phone: 440-542-5000