Provider Demographics
NPI:1104184068
Name:MEDCARE GROUP INC.
Entity type:Organization
Organization Name:MEDCARE GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-888-7487
Mailing Address - Street 1:6975 W 130TH ST
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7821
Mailing Address - Country:US
Mailing Address - Phone:440-888-7487
Mailing Address - Fax:440-888-7532
Practice Address - Street 1:6975 W 130TH ST
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7821
Practice Address - Country:US
Practice Address - Phone:440-888-7487
Practice Address - Fax:440-888-7532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH079249261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2879461Medicaid