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General NPI Number Information
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NPI Number | 1871639146
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Entity Type | Organization
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Legal Business Name | CLEVELAND VASCULAR INSTITUTE, LLC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 4100 WARRENSVILLE CENTER RD SUITE 1002
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City | WARRENSVILLE HEIGHTS
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State | OH
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Zip | 44122-7024
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Country | US
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Telephone | 216-991-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 WARRENSVILLE CENTER RD SUITE 1002
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City | WARRENSVILLE HEIGHTS
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State | OH
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Zip | 44122-7024
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Country | US
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Telephone | 216-991-2600
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN PRESIDENT
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Name | DR. JEFFREY A STANLEY
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Credential | D.O.
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Telephone | 216-991-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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