Provider Demographics
NPI:1538353966
Name:ROCKPORT MEDICAL CENTER INC
Entity type:Organization
Organization Name:ROCKPORT MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:ANTHONEY
Authorized Official - Last Name:MUSCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-251-5464
Mailing Address - Street 1:3665 W 117TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111
Mailing Address - Country:US
Mailing Address - Phone:216-251-5464
Mailing Address - Fax:216-251-5964
Practice Address - Street 1:3665 W 117TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5215
Practice Address - Country:US
Practice Address - Phone:216-251-5464
Practice Address - Fax:216-251-5964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9274711Medicare PIN