Provider Demographics
NPI:1124058920
Name:ID CONSULTANTS INC
Entity type:Organization
Organization Name:ID CONSULTANTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:ROTTURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-323-8987
Mailing Address - Street 1:1726 COLE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3262
Mailing Address - Country:US
Mailing Address - Phone:855-478-1528
Mailing Address - Fax:
Practice Address - Street 1:3401 ENTERPRISE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7340
Practice Address - Country:US
Practice Address - Phone:216-448-1060
Practice Address - Fax:216-450-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2519297Medicaid
OH0119080Medicaid
OH2624262Medicaid
OH2519288Medicaid
OH2485074Medicaid
OH2519279Medicaid
OH2519297Medicaid
OH0119080Medicaid
9260313Medicare ID - Type Unspecified
9260312Medicare ID - Type Unspecified
OH2519279Medicaid
OH2485074Medicaid