MEDICARE: WGT GROUP 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
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1336933274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WGT GROUP LLC

Provider Business Mailing Address
First Line	:	815 SUPERIOR AVE E STE 1618
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2709
Country	:	US
Telephone Number	:	866-238-8230
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 SUPERIOR AVE E STE 1618
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2709
Country	:	US
Telephone Number	:	866-238-8230
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LATONYA HANNIBAL
Credential	:
Telephone Number	:	440-541-3353

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

Similar Medicare Providers

1538822713 — MRS. CHARVETTA TERRIA SHANAE SMITH RN
Practice Location Address:

815 SUPERIOR AVE STE 1618
CLEVELAND, OH
44114-2709

Practice Phone: 216-202-5273
Practice Fax:

1982350351 — LINDSAY RYAN HEAD CNP
Practice Location Address:

815 SUPERIOR AVE STE 1618
CLEVELAND, OH
44114-2709

Practice Phone: 216-770-4691
Practice Fax:

1477246361 — MRS. AMANDA LAMBERT
Practice Location Address:

815 SUPERIOR AVE E STE 1618
CLEVELAND, OH
44114-2709

Practice Phone: 440-812-1113
Practice Fax:

1346079423 — CHEVE FRIERSON
Practice Location Address:

815 SUPERIOR AVE E STE 1618
CLEVELAND, OH
44114-2709

Practice Phone: 216-209-8799
Practice Fax:

1659168854 — AL PSYCHIATRY
Practice Location Address:

815 SUPERIOR AVE E STE 1618
CLEVELAND, OH
44114-2709

Practice Phone: 440-812-1113
Practice Fax:

1750219879 — SHAMEEKA SHARAYA WALKER
Practice Location Address:

7225 DELLENBAUGH AVE # 31
CLEVELAND, OH
44103-2709

Practice Phone: 216-326-8456
Practice Fax:

Directions to “WGT GROUP LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.