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General NPI Number Information
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NPI Number | 1225205800
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Entity Type | Organization
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Legal Business Name | CLEVELAND HEALTH VENTURES LLC
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 3420 FILBERT HWY
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City | CLOVER
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State | SC
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Zip | 29710-5602
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Country | US
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Telephone | 803-222-0600
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Fax | 803-222-6119
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Provider Business Mailing Address
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Address Line | PO BOX 601544
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City | CHARLOTTE
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State | NC
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Zip | 28260-1544
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Country | US
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Telephone | 803-222-0600
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Fax | 803-222-6119
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MR. DANIEL L WIENS
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Credential |
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Telephone | 704-355-0648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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