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General NPI Number Information
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NPI Number | 1316129075
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Entity Type | Organization
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Legal Business Name | OUTREACH PROFESSIONAL SERVICES INC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 29099 HEALTH CAMPUS DR SUITE 380
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City | WESTLAKE
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State | OH
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Zip | 44145
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Country | US
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Telephone | 440-827-5390
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Fax | 440-827-5344
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Provider Business Mailing Address
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Address Line | 26908 DETROIT RD SUITE 301
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City | WESTLAKE
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State | OH
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Zip | 44145-2398
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Country | US
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Telephone | 440-617-1823
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Fax | 440-617-0884
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MISTY A BLAYLOCK
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Credential |
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Telephone | 440-892-6406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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