Provider Demographics
NPI:1093909814
Name:JAMES LANE, M.D. INC
Entity Type:Organization
Organization Name:JAMES LANE, M.D. INC
Other - Org Name:ASSOCIATES IN CARDIOLOGY INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-381-1311
Mailing Address - Street 1:5 SEVERANCE CIR
Mailing Address - Street 2:#705
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1566
Mailing Address - Country:US
Mailing Address - Phone:216-381-1311
Mailing Address - Fax:216-381-2606
Practice Address - Street 1:5 SEVERANCE CIR
Practice Address - Street 2:#705
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1566
Practice Address - Country:US
Practice Address - Phone:216-381-1311
Practice Address - Fax:216-381-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044197174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2397937Medicaid
OH9335441OtherMEDICARE GROUP PROVIDER