NPIMap

Organization Active NPI

Lakewood Hospital Professional Services

  • Family Medicine Physician
  • Lakewood, OH
National Provider Identifier
1386699106
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LAKEWOOD HOSPITAL PROFESSIONAL SERVICES
Practice address
14600 Detroit Ave
Suite 103
Lakewood, OH 44107-4207
Phone
(216) 227-0717
Fax
(216) 227-0827
NPI assigned
May 23, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mark E Wiedt
Title
Chief Executive Officer
Phone
(440) 895-5021

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

14600 Detroit Ave
Suite 103
Lakewood, OH 44107-4207

Mailing address

20525 Center Ridge Rd
Suite 220
Rocky River, OH 44116-3437
Phone (440) 895-5021

National Provider Directory

National Provider Directory
Tax ID family
Lakewood Hospital Professional Services5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

14600 Detroit Ave
Ste 103
Lakewood, OH 44107
Phone (216) 227-0717

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386699106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20525 CENTER RIDGE RD",
            "address_2": "SUITE 220",
            "city": "ROCKY RIVER",
            "state": "OH",
            "postal_code": "441163437",
            "telephone_number": "440-895-5021",
            "fax_number": "440-895-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14600 DETROIT AVE",
            "address_2": "SUITE 103",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441074207",
            "telephone_number": "216-227-0717",
            "fax_number": "216-227-0827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD HOSPITAL PROFESSIONAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WIEDT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "440-895-5021"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.