St Judes Medical Clinic

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

35033404 Issued in OH

Legal business name

ST JUDES MEDICAL CLINIC

Practice address

7211 Broadway
Cleveland, OH 44105

Phone

(216) 271-1947

Fax

(216) 271-0106

NPI assigned

Aug 4, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Nelida R Enrique, MD

Title

President Treasurer

Phone

(216) 271-1947

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266796800000",
    "number": "1609884592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7211 BROADWAY",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44105",
            "telephone_number": "216-271-1947",
            "fax_number": "216-271-0106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7211 BROADWAY",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44105",
            "telephone_number": "216-271-1947",
            "fax_number": "216-271-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDES MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2010-02-22",
        "status": "A",
        "authorized_official_last_name": "ENRIQUE",
        "authorized_official_first_name": "NELIDA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT TREASURER",
        "authorized_official_telephone_number": "216-271-1947",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "OH",
            "license": "35033404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0325866",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Cleveland, OH
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• General Practice Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2010; 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.