Provider Demographics
NPI:1669522074
Name:SOUTHGATE OCCUPATIONAL MEDICINE AND THERAPY
Entity type:Organization
Organization Name:SOUTHGATE OCCUPATIONAL MEDICINE AND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HOCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-663-5680
Mailing Address - Street 1:20676 SOUTHGATE PARK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2953
Mailing Address - Country:US
Mailing Address - Phone:216-663-5680
Mailing Address - Fax:216-663-5690
Practice Address - Street 1:20676 SOUTHGATE PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2953
Practice Address - Country:US
Practice Address - Phone:216-663-5680
Practice Address - Fax:216-663-5690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID