Healthcare Provider Details

I. General information

NPI: 1184688996
Provider Name (Legal Business Name): SUBURBAN CARDIOLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 WARRENSVILLE CENTER ROAD
WARRENSVILLE HTS OH
44122
US

IV. Provider business mailing address

7500 OLD OAK BLVD
MIDDLEBURG HTS. OH
44130-0000
US

V. Phone/Fax

Practice location:
  • Phone: 216-751-6650
  • Fax:
Mailing address:
  • Phone: 440-777-6300
  • Fax: 440-777-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES LANE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 216-381-1311