Provider Demographics
NPI:1700052826
Name:MOUNT CARMEL HEALTH PROVIDERS INC
Entity Type:Organization
Organization Name:MOUNT CARMEL HEALTH PROVIDERS INC
Other - Org Name:VICTORIAN VILLAGE FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-546-4969
Mailing Address - Street 1:PO BOX 951603
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0018
Mailing Address - Country:US
Mailing Address - Phone:614-546-4400
Mailing Address - Fax:614-546-4441
Practice Address - Street 1:100 W 3RD AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3256
Practice Address - Country:US
Practice Address - Phone:614-299-6333
Practice Address - Fax:614-299-9331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9264991Medicare PIN