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General NPI Number Information
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NPI Number | 1235494550
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Entity Type | Organization
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Legal Business Name | GORDON & MANGAN TRAVELERS CLINIC, LLC
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 07/12/2012
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Provider Practice Location Address
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Address Line | 21825 CHAGRIN BLVD. SUITE 345
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City | BEACHWOOD
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State | OH
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Zip | 44122-5352
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Country | US
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Telephone | 216-295-9400
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Fax | 216-283-8120
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Provider Business Mailing Address
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Address Line | 21825 CHAGRIN BLVD. SUITE 345
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City | BEACHWOOD
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State | OH
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Zip | 44122-5352
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Country | US
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Telephone | 216-295-9400
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Fax | 216-283-8120
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Authorized Official
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Title or Position | CO-OWNER, EXECUTIVE DIRECTOR & CLIN
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Name | EILEEN KILBANE GORDON
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Credential | R.N.
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Telephone | 216-295-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN140601
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License Number State | OH
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