Provider Demographics
NPI:1184768616
Name:AUGUST HEALTH SERVICES INCORPORATED
Entity type:Organization
Organization Name:AUGUST HEALTH SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT-MEDICAL OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANZA
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:440-582-1484
Mailing Address - Street 1:12744 STATE ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133
Mailing Address - Country:US
Mailing Address - Phone:440-582-1484
Mailing Address - Fax:440-582-1321
Practice Address - Street 1:4850 HICKORY NUT LN
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-4640
Practice Address - Country:US
Practice Address - Phone:216-524-2521
Practice Address - Fax:216-524-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2379484Medicaid
OH2379484Medicaid