Provider Demographics
NPI:1104371640
Name:OUTREACH PROFESSIONAL SERVICES, INC
Entity Type:Organization
Organization Name:OUTREACH PROFESSIONAL SERVICES, INC
Other - Org Name:ST VINCENT MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-363-2626
Mailing Address - Street 1:PO BOX 932127
Mailing Address - Street 2:CLEVELAND
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2322 E 22ND ST STE 201
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3100
Practice Address - Country:US
Practice Address - Phone:216-363-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies