MEDICARE: KAISER PERMANENTE

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	:	1548363757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAISER PERMANENTE

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	:	5410 LANCASTER DR
Second Line	:
City	:	BROOKLYN HTS
State	:	OH
Zip	:	44131
Country	:	US
Telephone Number	:	216-265-8810
Fax Number	:	216-265-8890

Authorized Official
Title or Position	:	VP CFO
Name	:	TOM REVIS
Credential	:
Telephone Number	:	216-265-8844

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	01/16/2008

Similar Medicare Providers

1326056631 — MRS. ELIZABETH ANN BAISHNAB RPH
Practice Location Address:

5420 LANCASTER DR
BROOKLYN HTS, OH
44131-1832

Practice Phone: 216-676-6099
Practice Fax:

1457566168 — CUYAHOGA COUNTY BD. OF MRDD
Practice Location Address:

211 E SCHAAF RD
BROOKLYN HTS, OH
44131-1204

Practice Phone: 216-736-2625
Practice Fax: 216-736-2702

1225359656 — SHAYLA LESTER MD
Practice Location Address:

5500 LANCASTER DR
BROOKLYN HTS, OH
44131-1834

Practice Phone: 216-691-8600
Practice Fax: 216-691-8605

1437692274 — SUSAN MEGHAN DAVIS RN
Practice Location Address:

925 KEYNOTE CIRCLE SUITE #300
BROOKLYN HTS, OH
44131

Practice Phone: 216-931-1400
Practice Fax: 216-694-4181

1417411018 — KIM BROADNAX LISW
Practice Location Address:

925 KEYNOTE CIR STE 300
BROOKLYN HTS, OH
44131-1869

Practice Phone: 216-931-1400
Practice Fax:

1255898433 — ELIZABETH SPENCE
Practice Location Address:

806 TUXEDO AVE
BROOKLYN HTS, OH
44131

Practice Phone: 216-644-8643
Practice Fax:

Directions to “KAISER PERMANENTE ” 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.