=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275964348
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POEL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2013
-----------------------------------------------------
Last Update Date | 11/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1430 S HIGH ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43207-1045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-274-5000
-----------------------------------------------------
Fax | 440-716-8608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30701 LORAIN RD STE A
-----------------------------------------------------
City | NORTH OLMSTED
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44070-6325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-274-5000
-----------------------------------------------------
Fax | 440-716-8608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROGER GARCIA
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 440-274-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 34003736
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------