MEDICARE: EDWINA E SIMMONS MD

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	207V00000X	Obstetrics & Gynecology Physician	35056075	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00111439	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073502589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWINA E SIMMONS MD

Provider Business Mailing Address
First Line	:	24651 CENTER RIDGE RD
Second Line	:	SUITE 350
City	:	WESTLAKE
State	:	OH
Zip	:	44145-5635
Country	:	US
Telephone Number	:	440-895-5056
Fax Number	:	440-333-2935

Provider Business Practice Location Address
First Line	:	7225 OLD OAK BLVD
Second Line	:	SUITE B311
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3339
Country	:	US
Telephone Number	:	440-895-5056
Fax Number	:	440-333-2935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	08/14/2014

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Directions to “ EDWINA E SIMMONS MD” Practice Location

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