Provider Demographics
NPI:1912207440
Name:PHYSICIAN HOUSE CALL SERVICES LLC
Entity Type:Organization
Organization Name:PHYSICIAN HOUSE CALL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VYACHESLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-201-0339
Mailing Address - Street 1:402 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3604
Mailing Address - Country:US
Mailing Address - Phone:216-201-0339
Mailing Address - Fax:
Practice Address - Street 1:402 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-3604
Practice Address - Country:US
Practice Address - Phone:216-201-0339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIAN HOUSE CALL SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-01
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFV96521Medicare PIN