=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245489574
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST VINCENT CHARITY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2008
-----------------------------------------------------
Last Update Date | 09/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6809 MAYFIELD RD APT # 1050
-----------------------------------------------------
City | MAYFIELD HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44124-2273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-544-2165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6809 MAYFIELD RD APT # 1050
-----------------------------------------------------
City | MAYFIELD HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44124-2273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-544-2165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | DR. RICHARD CHRISTIE
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 216-861-6200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 57.011235
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------