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NPI Code Detail

MEDICARE: DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM

MEDICARE: DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
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
1261QS1000XStudent Health Clinic/Center

General Provider Information

NPI Number : 1619377942
Entity Type Code : Organization
Provider Name (Legal Business Name) : DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Provider Business Mailing Address
First Line : PO BOX 95460
Second Line :
City : CLEVELAND
State : OH
Zip : 44101-0033
Country : US
Telephone Number : 602-581-6088
Fax Number : 602-263-1619
Provider Business Practice Location Address
First Line : 9010 MAGNOLIA AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-4431
Country : US
Telephone Number : 951-509-8914
Fax Number : 602-200-5383
Authorized Official
Title or Position : CMO
Name : LAURA A TILLMAN
Credential : MD
Telephone Number : 602-263-1674
Provider Enumeration Date : 08/22/2014
Last Update Date : 05/26/2021

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Directions to “DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM ” Practice Location

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