Provider Demographics
NPI:1548208184
Name:UNIVERSITY OTOLARYNGOLOGY-HEAD & NECK SURGERY,INC
Entity Type:Organization
Organization Name:UNIVERSITY OTOLARYNGOLOGY-HEAD & NECK SURGERY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-844-3002
Mailing Address - Street 1:3605 WARRENSVILLE CENTER RD
Mailing Address - Street 2:1ST FLOOR - MSC9152
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5203
Mailing Address - Country:US
Mailing Address - Phone:216-286-6299
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1736
Practice Address - Country:US
Practice Address - Phone:216-844-3002
Practice Address - Fax:216-286-6341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0597037Medicaid
OHCA7601OtherRAILROAD MEDICARE
OHCA7601OtherRAILROAD MEDICARE
OHCA7601OtherRAILROAD MEDICARE