MEDICARE: MOUNT CARMEL HEALTH PROVIDERS INC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1720253842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT CARMEL HEALTH PROVIDERS INC

Provider Business Mailing Address
First Line	:	PO BOX 951603
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0018
Country	:	US
Telephone Number	:	614-546-4400
Fax Number	:	614-546-4441

Provider Business Practice Location Address
First Line	:	2872 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-2645
Country	:	US
Telephone Number	:	614-274-9007
Fax Number	:	614-274-3339

Authorized Official
Title or Position	:	COO
Name	:	PAUL C SCHUTTE
Credential	:
Telephone Number	:	614-546-4424

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	04/29/2008

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