Gordon & Mangan Travelers Clinic, LLC

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN140601 Issued in OH

Legal business name

GORDON & MANGAN TRAVELERS CLINIC, LLC

Doing business as

Passport Health Northern Ohio

Practice address

21825 Chagrin Blvd.
Suite 345
Beachwood, OH 44122-5352

Phone

(216) 295-9400

Fax

(216) 283-8120

NPI assigned

Jul 12, 2012

Last updated

Jul 12, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Eileen Kilbane Gordon, R.N.

Title

Co-Owner, Executive Director & Clin

Phone

(216) 295-9400

Specialties & licenses 1

Addresses

Other names 1

• Passport Health Northern Ohio Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342051200000",
    "number": "1235494550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21825 CHAGRIN BLVD.",
            "address_2": "SUITE 345",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225352",
            "telephone_number": "216-295-9400",
            "fax_number": "216-283-8120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21825 CHAGRIN BLVD.",
            "address_2": "SUITE 345",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225352",
            "telephone_number": "216-295-9400",
            "fax_number": "216-283-8120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GORDON & MANGAN TRAVELERS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-12",
        "last_updated": "2012-07-12",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "EILEEN",
        "authorized_official_middle_name": "KILBANE",
        "authorized_official_title_or_position": "CO-OWNER, EXECUTIVE DIRECTOR & CLIN",
        "authorized_official_telephone_number": "216-295-9400",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN140601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Passport Health Northern Ohio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth A Goodwin, PCC
• Heidi A Goodwin, MSN CNM CNP
• India Goodwin
• Russell J Goodwin, LPC, LICDC
• Rajesh Gopalarathinam, MD
• Gordon Dental Care, Inc.
• Barry Hale Gordon, PH.D.
• Jessie Gordon, LPCC
• Jonathan D Gordon, PH.D.
• Julian A Gordon, MD

• Registered Nurse in Beachwood, OH
• Providers in Beachwood, OH by specialty
• Registered Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.