Provider Demographics
NPI:1962681932
Name:MINDFUL MEDICINE, INC.
Entity Type:Organization
Organization Name:MINDFUL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EHRENBEIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-708-0598
Mailing Address - Street 1:3690 ORANGE PL
Mailing Address - Street 2:STE 410
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4464
Mailing Address - Country:US
Mailing Address - Phone:216-292-6288
Mailing Address - Fax:
Practice Address - Street 1:3690 ORANGE PL
Practice Address - Street 2:STE 410
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4464
Practice Address - Country:US
Practice Address - Phone:216-292-6288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-071457B2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9335701Medicare PIN