MEDICARE: CLINIC MEDICAL SERVICES COMPANY

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1215234976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINIC MEDICAL SERVICES COMPANY

Provider Business Mailing Address
First Line	:	6100 W CREEK RD STE 35
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2133
Country	:	US
Telephone Number	:	216-642-8165
Fax Number	:	216-642-1064

Provider Business Practice Location Address
First Line	:	1449 BOARDMAN CANFIELD RD STE 140
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-8070
Country	:	US
Telephone Number	:	330-965-7370
Fax Number	:	330-965-7377

Authorized Official
Title or Position	:	DIRECTOR, BUSINESS OPERATIONS
Name	:	MR. GEORGE KAFITI
Credential	:
Telephone Number	:	216-445-5023

Provider Enumeration Date	:	02/16/2011
Last Update Date	:	02/16/2011

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