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MAXILLOFACIAL SURGERY INNOVATIVE SERVICES NPI 1962929240


NPI Information

NPI: 1962929240
Provider Name: MAXILLOFACIAL SURGERY INNOVATIVE SERVICES
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
1284 SOM CENTER RD STE 219
MAYFIELD HEIGHTS, OH
ZIP 44124
Phone: (888) 774-7773
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MAXILLOFACIAL SURGERY INNOVATIVE SERVICES is a clinic center in Mayfield Heights, OH. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). MAXILLOFACIAL SURGERY INNOVATIVE SERVICES NPI is 1962929240. The provider is registered as an organization entity type.

The provider's business location address is:

1284 SOM CENTER RD STE 219
MAYFIELD HEIGHTS, OH
ZIP 44124-048
Phone: (888) 774-7773
Fax: (888) 774-7970

The provider's authorized official is Michelle Ann Hancock .
The authorized official title is Credentialing Director and has the following contact phone number (515) 321-6451.

The enumeration date for this NPI number is 8/28/2017 and was last updated on 7/21/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/CenterYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12855503MEDICAIDOHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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