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General NPI Number Information
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NPI Number | 1831571272
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Entity Type | Organization
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Legal Business Name | ST. VINCENT CHARITY MEDICAL CENTER
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Dates
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Enumeration Date | 06/22/2015
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Last Update Date | 06/22/2015
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Provider Practice Location Address
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Address Line | 2351 E 22ND ST
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City | CLEVELAND
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State | OH
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Zip | 44115-3111
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Country | US
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Telephone | 906-458-3216
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Fax |
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Provider Business Mailing Address
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Address Line | 2351 E 22ND ST
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City | CLEVELAND
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State | OH
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Zip | 44115-3111
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Country | US
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Telephone | 906-458-3216
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Fax |
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Authorized Official
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Title or Position | RESIDENCY DIRECTOR
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Name | DR. WISSAM KHOURY
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Credential | D.P.M
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Telephone | 216-367-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 59
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License Number State | OH
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