MEDICARE: CLEVELAND VASCULAR INSTITUTE, LLC

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	363L00000X	Nurse Practitioner
2	2086S0129X	Vascular Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DA6647	OTHER		RR MEDICARE

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	:	1871639146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND VASCULAR INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	4100 WARRENSVILLE CENTER RD
Second Line	:	SUITE 1002
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44122-7024
Country	:	US
Telephone Number	:	216-991-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 WARRENSVILLE CENTER RD
Second Line	:	SUITE 1002
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44122-7024
Country	:	US
Telephone Number	:	216-991-2600
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN PRESIDENT
Name	:	DR. JEFFREY A STANLEY
Credential	:	D.O.
Telephone Number	:	216-991-2600

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	06/08/2011

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Directions to “CLEVELAND VASCULAR INSTITUTE, LLC ” Practice Location

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