Basic Information
| Provider Information | |||||||||
| NPI: | 1740552223 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT VINCENT CHARITY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3410 WOOSTER RD | ||||||||
| Address2: | APARTMENT #312 | ||||||||
| City: | ROCKY RIVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441164173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404295198 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2351 E 22ND ST | ||||||||
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| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441153111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168616200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2012 | ||||||||
| LastUpdateDate: | 01/31/2012 | ||||||||
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| AuthorizedOfficialLastName: | DINARY | ||||||||
| AuthorizedOfficialFirstName: | BUTHAYNA | ||||||||
| AuthorizedOfficialMiddleName: | ALKHATIB | ||||||||
| AuthorizedOfficialTitleorPosition: | INTERNAL MEDIICNE | ||||||||
| AuthorizedOfficialTelephone: | 4404295198 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 57.019014 | OH | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.