MEDICARE: METROHEALTH CONCORDIA CARE

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	3336I0012X	Institutional Pharmacy	021459150	OH

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
2	3674517	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1700836715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROHEALTH CONCORDIA CARE

Provider Business Mailing Address
First Line	:	PO BOX 73122
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2373 EUCLID HEIGHTS BLVD RM 101
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-2705
Country	:	US
Telephone Number	:	216-791-3580
Fax Number	:	216-791-3281

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	PAMELA SPEARS
Credential	:	RPH
Telephone Number	:	216-791-3580

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	05/30/2008

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Directions to “METROHEALTH CONCORDIA CARE ” Practice Location

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