=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659468155
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEPHROLOGY ASSOCIATES OF CLEVELAND, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5595 TRANSPORTATION BLVD SUITE 110
-----------------------------------------------------
City | GARFIELD HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44125-5359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-581-0801
-----------------------------------------------------
Fax | 216-581-0866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18720 CHAGRIN BLVD
-----------------------------------------------------
City | SHAKER HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-4855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-295-7003
-----------------------------------------------------
Fax | 216-295-7014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | GAYLE A NEMECEK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-658-0458
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number | 0767DC
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------