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General NPI Number Information
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NPI Number | 1942519863
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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 | 09/27/2010
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Last Update Date | 09/27/2010
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Provider Practice Location Address
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Address Line | 18099 LORAIN AVE SUITE 312
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City | CLEVELAND
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State | OH
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Zip | 44111-5610
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Country | US
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Telephone | 216-941-0066
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Fax | 216-941-3667
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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