Provider Demographics
NPI:1508950353
Name:IDEAL HEALTH OF STRONGSVILLE, INC.
Entity Type:Organization
Organization Name:IDEAL HEALTH OF STRONGSVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-268-9563
Mailing Address - Street 1:PO BOX 360817
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136
Mailing Address - Country:US
Mailing Address - Phone:440-268-9563
Mailing Address - Fax:440-268-9593
Practice Address - Street 1:19640 W. 130TH STREET
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136
Practice Address - Country:US
Practice Address - Phone:440-268-9563
Practice Address - Fax:440-268-9593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDE5043OtherRAILROAD MEDICARE
OH2462339OtherUNITED HEALTHCARE
OH=========OtherAETNA GROUP #
OH=========OtherANTHEM BLUE CROSS BLUE SH
OH=========-001OtherMEDICAL MUTUAL OF OHIO
OH=========OtherQUALCHOICE
OH9347001Medicare ID - Type UnspecifiedMEDICARE GROUP #