Provider Demographics
NPI:1376538363
Name:FAITH MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:FAITH MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-791-0017
Mailing Address - Street 1:11201 SHAKER BLVD
Mailing Address - Street 2:240
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3869
Mailing Address - Country:US
Mailing Address - Phone:216-791-0017
Mailing Address - Fax:216-791-0021
Practice Address - Street 1:11201 SHAKER BLVD
Practice Address - Street 2:240
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3869
Practice Address - Country:US
Practice Address - Phone:216-791-0017
Practice Address - Fax:216-791-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0185839Medicaid
OH0185839Medicaid
OHFA9314571Medicare ID - Type UnspecifiedSHAKER OFFICE
OHFA9314572Medicare ID - Type UnspecifiedSOLON OFFICE
OHFA9314574Medicare ID - Type UnspecifiedPARMA OFFICE