Provider Demographics
NPI:1942274840
Name:ST VINCENT CHARITY MEDICAL CENTER
Entity Type:Organization
Organization Name:ST VINCENT CHARITY MEDICAL CENTER
Other - Org Name:ST VINCENT CHARITY OCCUPATIONAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-875-4602
Mailing Address - Street 1:6935 TREELINE DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3393
Mailing Address - Country:US
Mailing Address - Phone:440-746-3401
Mailing Address - Fax:440-746-3405
Practice Address - Street 1:2475 E 22ND ST
Practice Address - Street 2:SUITE 310
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3221
Practice Address - Country:US
Practice Address - Phone:216-363-2691
Practice Address - Fax:440-746-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34189345202OtherBUREAU OF WORKERS' COMPEN
OH=========04OtherBUREAU OF WORKERS' COMPENSATION