Provider Demographics
NPI:1851540280
Name:TWO BROTHERS ENTERPRISES INC
Entity Type:Organization
Organization Name:TWO BROTHERS ENTERPRISES INC
Other - Org Name:INDEPENDENCE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LENORE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-573-1300
Mailing Address - Street 1:4400 ROCKSIDE RD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2168
Mailing Address - Country:US
Mailing Address - Phone:216-573-1300
Mailing Address - Fax:216-503-5005
Practice Address - Street 1:4400 ROCKSIDE RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2168
Practice Address - Country:US
Practice Address - Phone:216-573-1300
Practice Address - Fax:216-503-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2878060Medicaid
OH000000590089OtherANTHEM BLUE SHIELD
OHDO4837Medicare PIN
OH000000590089OtherANTHEM BLUE SHIELD