=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942963996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE METROHEALTH SYSTEM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2021
-----------------------------------------------------
Last Update Date | 10/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9885 ROCKSIDE RD STE 157
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44125-6272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 112-167-7888
-----------------------------------------------------
Fax | 216-957-4760
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9885 ROCKSIDE RD STE 157
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44125-6272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-957-4770
-----------------------------------------------------
Fax | 216-957-4760
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCE AND BUSINESS MANAGER
-----------------------------------------------------
Name | BRANDON MARK DOPPELHEUER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-778-8880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------