Provider Demographics
NPI:1619095049
Name:BROWN MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:BROWN MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DELORISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-451-2030
Mailing Address - Street 1:1831 FOREST HILLS BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-4348
Mailing Address - Country:US
Mailing Address - Phone:216-451-2030
Mailing Address - Fax:216-451-2027
Practice Address - Street 1:1831 FOREST HILLS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4348
Practice Address - Country:US
Practice Address - Phone:216-451-2030
Practice Address - Fax:216-451-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No209800000XAllopathic & Osteopathic PhysiciansLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000168701OtherANTHEM GROUP PROVIDER ID
OH50821OtherQUALCHOICE PROVIDER ID
OH587127472010OtherMEDICAL MUTUAL OF OHIO ID
OH716326Medicaid
OHR39059OtherSUMMACARE PROVIDER ID
OH366373800OtherUS DEPARTMENT OF LABOR ID
OH350477OtherWELLCARE HEALTH PLANS ID
OH350477Medicaid
OH0420315Medicaid
OH366373800OtherFEDERAL WORKERS COMP
OH716326Medicaid
OH350477OtherWELLCARE HEALTH PLANS ID
OH0420315Medicaid
OH350477Medicaid
OH587127472010OtherMEDICAL MUTUAL OF OHIO ID
OH110212700Medicare ID - Type UnspecifiedRAILROAD MEDICARE PROV ID