Provider Demographics
NPI:1881006260
Name:HEALTHSPAN PHYSICIANS, LLC
Entity Type:Organization
Organization Name:HEALTHSPAN PHYSICIANS, LLC
Other - Org Name:HEALTHSPAN PHYSICIANS - MEDINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MILECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-265-8811
Mailing Address - Street 1:12301 SNOW RD
Mailing Address - Street 2:REVENUE CYCLE DEPARTMENT
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1002
Mailing Address - Country:US
Mailing Address - Phone:866-265-8844
Mailing Address - Fax:216-265-8890
Practice Address - Street 1:3443 MEDINA RD
Practice Address - Street 2:SUITE 108
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5360
Practice Address - Country:US
Practice Address - Phone:330-764-3077
Practice Address - Fax:330-764-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
7132360001Medicare NSC