Provider Demographics
NPI:1770671752
Name:MEDICAL CARE CENTER LLC
Entity Type:Organization
Organization Name:MEDICAL CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:SMIRNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-621-5275
Mailing Address - Street 1:1250 SUPERIOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114
Mailing Address - Country:US
Mailing Address - Phone:216-621-5275
Mailing Address - Fax:216-621-6711
Practice Address - Street 1:1250 SUPERIOR AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114
Practice Address - Country:US
Practice Address - Phone:216-621-5275
Practice Address - Fax:216-621-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2171484Medicaid
7374044OtherAETNA
7374044OtherAETNA
=========OtherUNITED HEALTH CARE
OH=========00OtherWORKERS COMP
OH2171484Medicaid
7374044OtherAETNA
=========001OtherMEDICAL MUTUAL