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NPI Code Detail

MEDICARE: EMBASSY BROADWAY MANAGEMENT, LLC

MEDICARE: EMBASSY BROADWAY MANAGEMENT, LLC
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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1336454800
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMBASSY BROADWAY MANAGEMENT, LLC
Provider Business Mailing Address
First Line : 16231 BROADWAY AVE
Second Line :
City : MAPLE HEIGHTS
State : OH
Zip : 44137-2526
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 16231 BROADWAY AVE
Second Line :
City : MAPLE HEIGHTS
State : OH
Zip : 44137-2526
Country : US
Telephone Number : 216-662-0551
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : AARON HANDLER
Credential :
Telephone Number : 216-662-0551
Provider Enumeration Date : 08/09/2010
Last Update Date : 08/09/2010

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