Provider Demographics
NPI:1023118254
Name:CHAMPION'S CLINICAL
Entity type:Organization
Organization Name:CHAMPION'S CLINICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-589-9447
Mailing Address - Street 1:1873 PROSPECT AVE E
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2313
Mailing Address - Country:US
Mailing Address - Phone:216-589-9447
Mailing Address - Fax:216-589-9446
Practice Address - Street 1:1873 PROSPECT AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2313
Practice Address - Country:US
Practice Address - Phone:216-589-9447
Practice Address - Fax:216-589-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory