Provider Demographics
NPI:1457378341
Name:PHYSICIAN SERVICES OF CLEVELAND, PC
Entity Type:Organization
Organization Name:PHYSICIAN SERVICES OF CLEVELAND, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:SINK
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:423-479-9679
Mailing Address - Street 1:2650 EXECUTIVE PARK NW
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2746
Mailing Address - Country:US
Mailing Address - Phone:423-479-9679
Mailing Address - Fax:423-559-9046
Practice Address - Street 1:2650 EXECUTIVE PARK NW
Practice Address - Street 2:SUITE 5
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2746
Practice Address - Country:US
Practice Address - Phone:423-479-9679
Practice Address - Fax:423-559-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3716092Medicare ID - Type Unspecified