Provider Demographics
NPI:1699829788
Name:NORTHCOAST INFUSION THERAPIES LTD.
Entity Type:Organization
Organization Name:NORTHCOAST INFUSION THERAPIES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH PHARMD
Authorized Official - Phone:440-735-7150
Mailing Address - Street 1:7710 FIRST PL
Mailing Address - Street 2:BLDG E, SUITE H
Mailing Address - City:OAKWOOD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44146-6717
Mailing Address - Country:US
Mailing Address - Phone:440-735-7150
Mailing Address - Fax:440-735-7155
Practice Address - Street 1:232 WEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2110
Practice Address - Country:US
Practice Address - Phone:440-735-7150
Practice Address - Fax:440-735-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-100200251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2007901Medicaid
OH=========002OtherMEDICAL MUTUAL OF OHIO
OH2007901Medicaid
OH2007901Medicaid