Provider Demographics
NPI:1568796506
Name:MOUNT CARMEL HEALTH PROVIDERS TWO LLC
Entity Type:Organization
Organization Name:MOUNT CARMEL HEALTH PROVIDERS TWO LLC
Other - Org Name:MOUNT CARMEL NEUROLOGY PROVIDERS AT GRANVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IMPLEMENTATION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-546-4956
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 1:2000 NEWARK GRANVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-7009
Practice Address - Country:US
Practice Address - Phone:614-882-2581
Practice Address - Fax:614-882-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty