MEDICARE: KAISER FOUNDATION HEALTH PLAN OF OHIO

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528161734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAISER FOUNDATION HEALTH PLAN OF OHIO

Provider Business Mailing Address
First Line	:	12301 SNOW ROAD
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44130
Country	:	US
Telephone Number	:	216-265-8810
Fax Number	:	216-265-8890

Provider Business Practice Location Address
First Line	:	10 SEVERENCE CIRCLE
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118
Country	:	US
Telephone Number	:	216-265-8810
Fax Number	:	216-265-8890

Authorized Official
Title or Position	:	VP CFO
Name	:	CRAIG FAERBER
Credential	:
Telephone Number	:	216-479-5136

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	10/31/2012

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