Provider Demographics
NPI:1467687178
Name:MOUNT CARMEL HEALTH PROVIDERS TWO, LLC
Entity Type:Organization
Organization Name:MOUNT CARMEL HEALTH PROVIDERS TWO, LLC
Other - Org Name:VASCULAR AND ENDOVASCULAR SURGICAL PROVIDERS (SOUDER)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IMPLEMENTATION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:N
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-546-4672
Mailing Address - Street 1:PO BOX 951144
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0005
Mailing Address - Country:US
Mailing Address - Phone:614-546-4400
Mailing Address - Fax:614-546-4441
Practice Address - Street 1:51 S SOUDER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1548
Practice Address - Country:US
Practice Address - Phone:614-221-1009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty