Provider Demographics
NPI:1346330529
Name:MPPS GEORGIAN, LLC
Entity Type:Organization
Organization Name:MPPS GEORGIAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-731-3618
Mailing Address - Street 1:730 SOM CENTER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2350
Mailing Address - Country:US
Mailing Address - Phone:440-446-9800
Mailing Address - Fax:440-460-9810
Practice Address - Street 1:730 SOM CENTER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44143-2350
Practice Address - Country:US
Practice Address - Phone:440-446-9800
Practice Address - Fax:440-460-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography