NPIMap

Organization Active NPI

Lake Health-University Hospitals Seidman Cancer Center

  • Radiation Oncology Physician
  • Mentor, OH
National Provider Identifier
1285713842
Registry record updated Nov 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
LAKE HEALTH-UNIVERSITY HOSPITALS SEIDMAN CANCER CENTER
Practice address
9485 Mentor Ave
Suite 3
Mentor, OH 44060-4597
Phone
(440) 205-5759
Fax
(440) 205-5790
NPI assigned
Nov 3, 2006
Last updated
Nov 11, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2013

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

Authorized official

Name
Julie Moran
Title
Executive Director
Phone
(440) 205-5759

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X NU Primary

Addresses

Primary practice location

9485 Mentor Ave
Suite 3
Mentor, OH 44060-4597

Mailing address

9485 Mentor Ave
Suite 3
Mentor, OH 44060-4597
Phone (440) 205-5759

Other identifiers 1

IdentifierTypeStateIssuer
2103315MedicaidOH

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

9485 Mentor Ave
Ste 3
Mentor, OH 44060
Phone (440) 205-5755

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384128000000",
    "number": "1285713842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9485 MENTOR AVE",
            "address_2": "SUITE 3",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440604597",
            "telephone_number": "440-205-5759",
            "fax_number": "440-205-5790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9485 MENTOR AVE",
            "address_2": "SUITE 3",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440604597",
            "telephone_number": "440-205-5759",
            "fax_number": "440-205-5790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HEALTH-UNIVERSITY HOSPITALS SEIDMAN CANCER CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2013-11-11",
        "status": "A",
        "authorized_official_last_name": "MORAN",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "440-205-5759"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2103315",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mentor, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2013; 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.