MEDICARE: EASTSIDE MEDICAL GROUP

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1346625050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTSIDE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	2775 S MORELAND BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-2397
Country	:	US
Telephone Number	:	216-751-8988
Fax Number	:	216-751-8990

Provider Business Practice Location Address
First Line	:	2775 S MORELAND BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-2397
Country	:	US
Telephone Number	:	216-751-8988
Fax Number	:	216-751-8990

Authorized Official
Title or Position	:	OWNER
Name	:	LAUCHLIN MCKEIGAN
Credential	:	D.C.
Telephone Number	:	440-725-8984

Provider Enumeration Date	:	07/23/2015
Last Update Date	:	06/21/2016

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Directions to “EASTSIDE MEDICAL GROUP ” Practice Location

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