Organization
OUTREACH PROFESSIONAL SERVICES INC
Active
Other names
St Vincent Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN RUSNACZYK (SENIOR VICE PRESIDENT & CFO)
(216) 363-2730
Entity
Organization
Contact information
Practice address
2351 E 22ND ST, CLEVELAND, OH 44115-3111
(216) 363-2730
Mailing address
PO BOX 932127, CLEVELAND, OH 44193-0008
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
213E00000X
Podiatrist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0251856
—
OH
Enumeration date
08/23/2006
Last updated
08/02/2016
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