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General NPI Number Information
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NPI Number | 1801688619
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Entity Type | Organization
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Legal Business Name | WATERTOWER PLAZA MEDICAL
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 25200 CHAGRIN BLVD STE 302
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City | BEACHWOOD
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State | OH
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Zip | 44122-5685
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Country | US
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Telephone | 216-302-0947
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Fax |
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Provider Business Mailing Address
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Address Line | 1610 MENTOR AVE STE 2
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City | PAINESVILLE
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State | OH
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Zip | 44077-1745
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Country | US
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Telephone | 440-352-4321
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Fax | 440-352-4321
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Authorized Official
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Title or Position | BILLING AND CREDENTIALING MGR
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Name | LINDA L GROVES
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Credential | CPC COC MBP CMA
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Telephone | 440-352-4321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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