MEDICARE: KAISER FOUNDATION HEALTH PLAN OF OHIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1023032620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAISER FOUNDATION HEALTH PLAN OF OHIO

Provider Business Mailing Address
First Line	:	5420 LANCASTER DR
Second Line	:
City	:	BROOKLYN HEIGHTS
State	:	OH
Zip	:	44131-1832
Country	:	US
Telephone Number	:	216-749-8383
Fax Number	:	216-778-6040

Provider Business Practice Location Address
First Line	:	5420 LANCASTER DR
Second Line	:
City	:	BROOKLYN HEIGHTS
State	:	OH
Zip	:	44131-1832
Country	:	US
Telephone Number	:	216-749-8383
Fax Number	:	216-778-6040

Authorized Official
Title or Position	:	VICE PRESIDENT AND CHIEF FINANCIAL
Name	:	THOMAS R REVIS
Credential	:
Telephone Number	:	216-479-5136

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	01/05/2011

Similar Medicare Providers

1568499234 — MR. JEFFREY A. WALLACE I R.PH.
Practice Location Address:

5420 LANCASTER DR , KAISER PERMANENTE PHARMACY ADMINISTRATION
BROOKLYN HEIGHTS, OH
44131-1832

Practice Phone: 216-749-8408
Practice Fax: 216-749-8426

1083648760 — MS. KATHLEEN A NEUGEBAUER R.PH.
Practice Location Address:

5420 LANCASTER DR
BROOKLYN HEIGHTS, OH
44131-1832

Practice Phone: 216-635-4493
Practice Fax:

1962416180 — MR. FRED S LEFTON R.PH.
Practice Location Address:

5420 LANCASTER DR
BROOKLYN HEIGHTS, OH
44131-1832

Practice Phone: 216-778-6053
Practice Fax:

1851305692 — SUSAN AYERS R.PH.
Practice Location Address:

5420 LANCASTER DR , PHARMACY ADMINISTRATION
BROOKLYN HEIGHTS, OH
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Practice Fax:

1609881424 — MRS. MELANIE BETH ROLSEN R.PH.
Practice Location Address:

5420 LANCASTER DR
BROOKLYN HEIGHTS, OH
44131-1832

Practice Phone: 216-778-6050
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1326055039 — RICHARD GREGORY POORE RPH
Practice Location Address:

5420 LANCASTER DR
BROOKLYN HEIGHTS, OH
44131-1832

Practice Phone: 216-749-8409
Practice Fax:

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