Provider Demographics
NPI:1861646804
Name:ORION MAPLE HEIGHTS LLC
Entity type:Organization
Organization Name:ORION MAPLE HEIGHTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-416-0600
Mailing Address - Street 1:16231 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2526
Mailing Address - Country:US
Mailing Address - Phone:216-662-0551
Mailing Address - Fax:
Practice Address - Street 1:16231 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2526
Practice Address - Country:US
Practice Address - Phone:216-662-0551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORION OPERATING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0338925291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory