Provider Demographics
NPI:1184688996
Name:SUBURBAN CARDIOLOGY SERVICES
Entity Type:Organization
Organization Name:SUBURBAN CARDIOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
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 1:7500 OLD OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44130-0000
Mailing Address - Country:US
Mailing Address - Phone:440-777-6300
Mailing Address - Fax:440-777-2330
Practice Address - Street 1:4180 WARRENSVILLE CENTER ROAD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HTS
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-751-6650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0721517Medicaid
OH0721517Medicaid