Provider Demographics
NPI:1154395820
Name:ST VINCENT CHARITY MEDICAL CENTER
Entity type:Organization
Organization Name:ST VINCENT CHARITY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-875-4602
Mailing Address - Street 1:6935 TREELINE DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3393
Mailing Address - Country:US
Mailing Address - Phone:440-746-3401
Mailing Address - Fax:440-746-3405
Practice Address - Street 1:2351 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3111
Practice Address - Country:US
Practice Address - Phone:216-861-6200
Practice Address - Fax:440-746-3405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT CHARITY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-17
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
341893452002OtherCHAMPUS
OH341893452006OtherMEDICAL MUTUAL OF OHIO
341893452002OtherCHAMPUS