Provider Demographics
NPI:1194097964
Name:SAINT RAPHAEL HEALTHCARE SYSTEM AFFILIATED PHYSICIANS INC
Entity type:Organization
Organization Name:SAINT RAPHAEL HEALTHCARE SYSTEM AFFILIATED PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR APSR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:203-789-6283
Mailing Address - Street 1:6880 W SNOWVILLE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-6283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty