Provider Demographics
NPI:1033440706
Name:MOUNT CARMEL HEALTH PROVIDERS TWO LLC
Entity Type:Organization
Organization Name:MOUNT CARMEL HEALTH PROVIDERS TWO LLC
Other - Org Name:BREAST SURGERY AT TAYLOR STATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IMPLEMENTATION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-546-4956
Mailing Address - Street 1:PO BOX 951144
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193
Mailing Address - Country:US
Mailing Address - Phone:614-546-4400
Mailing Address - Fax:614-546-4411
Practice Address - Street 1:150 TAYLOR STATION ROAD
Practice Address - Street 2:SUITE 140
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-221-0716
Practice Address - Fax:614-221-0728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty