Organization
OUTREACH PROFESSIONAL SERVICES INC
Active
Organization
OUTREACH PROFESSIONAL SERVICES INC
Active
Other names
Cuyahoga Physician Network
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY A BLAYLOCK (CREDENTIALING COORDINATOR)
(440) 892-6406
Entity
Organization
Contact information
Practice address
15900 SNOW RD, SUITE 200, BROOK PARK, OH 44142
(216) 676-1234
(216) 676-5876
Mailing address
26908 DETROIT RD, SUITE 301, WESTLAKE, OH 44145-2398
(440) 617-1823
(440) 617-0884
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
207L00000X
Anesthesiology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
213E00000X
Podiatrist
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0251856
—
OH
Enumeration date
11/14/2007
Last updated
01/12/2010
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