MEDICARE: EAST PARK CARE CENTER

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	36D0339113	OH

General Provider Information

NPI Number	:	1578726733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST PARK CARE CENTER

Provider Business Mailing Address
First Line	:	8 E PARK CIR
Second Line	:
City	:	BROOK PARK
State	:	OH
Zip	:	44142-3800
Country	:	US
Telephone Number	:	216-267-7229
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 E PARK CIR
Second Line	:
City	:	BROOK PARK
State	:	OH
Zip	:	44142-3800
Country	:	US
Telephone Number	:	216-267-7229
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	BOB NEMETZ
Credential	:
Telephone Number	:	440-250-4080

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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Directions to “EAST PARK CARE CENTER ” Practice Location

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