NPIMap

Organization Active NPI

Lake Health-University Hospitals Seidman Cancer Ctr Physicians Inc

  • Hematology & Oncology Physician
  • Mentor, OH
National Provider Identifier
1356394357
Registry record updated Jul 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
LAKE HEALTH-UNIVERSITY HOSPITALS SEIDMAN CANCER CTR PHYSICIANS INC
Practice address
9485 Mentor Ave Ste 3
Mentor, OH 44060-8711
Phone
(440) 205-5775
Fax
(440) 205-5733
NPI assigned
May 19, 2006
Last updated
Jul 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2014

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
Hematology & Oncology Physician 207RH0003X NU Primary

Addresses

Primary practice location

9485 Mentor Ave Ste 3
Mentor, OH 44060-8711

Mailing address

9485 Mentor Ave Ste 3
Mentor, OH 44060-8711
Phone (440) 205-5755

Other identifiers 2

IdentifierTypeStateIssuer
2144250OtherPK
2560590MedicaidOH

National Provider Directory

National Provider Directory

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": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404345600000",
    "number": "1356394357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9485 MENTOR AVE STE 3",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440608711",
            "telephone_number": "440-205-5755",
            "fax_number": "440-205-5743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9485 MENTOR AVE STE 3",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440608711",
            "telephone_number": "440-205-5775",
            "fax_number": "440-205-5733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HEALTH-UNIVERSITY HOSPITALS SEIDMAN CANCER CTR PHYSICIANS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2014-07-03",
        "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": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2144250",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2560590",
            "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 Jul 3, 2014; 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.