MEDICARE: JACQUELYN D URBAN M.D.

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	146D00000X	Personal Emergency Response Attendant	35049954	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00220796	OTHER	OH	MEDICARE TRAVELERS RR-GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	942460636052	OTHER	OH	CARESOURCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457308207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN D URBAN M.D.

Provider Business Mailing Address
First Line	:	16930 GLEN RD
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-9501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 W 25TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-3108
Country	:	US
Telephone Number	:	216-696-4300
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	06/07/2026

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