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NPI Code Detail

MEDICARE: CLEVELAND AVENUE PROFESSIONAL CENTER

MEDICARE: CLEVELAND AVENUE PROFESSIONAL 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
1261QA1903XAmbulatory Surgical Clinic/Center35075146-SOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922193010
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLEVELAND AVENUE PROFESSIONAL CENTER
Provider Business Mailing Address
First Line : 200 BRADENTON AVE
Second Line :
City : DUBLIN
State : OH
Zip : 43017-7515
Country : US
Telephone Number : 614-793-1980
Fax Number :
Provider Business Practice Location Address
First Line : 5910 CLEVELAND AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43231-6881
Country : US
Telephone Number : 614-882-4343
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MILROY J. SAMUEL
Credential : M.D.
Telephone Number : 614-882-4343
Provider Enumeration Date : 10/04/2006
Last Update Date : 03/17/2008

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Directions to “CLEVELAND AVENUE PROFESSIONAL CENTER ” Practice Location

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