Healthcare Provider Details

I. General information

NPI: 1639413453
Provider Name (Legal Business Name): ELYRIA MEDICLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 ABBE RD N
ELYRIA OH
44035-1649
US

IV. Provider business mailing address

156 CLEVELAND STREET
ELYRIA OH
44035
US

V. Phone/Fax

Practice location:
  • Phone: 440-366-0455
  • Fax: 440-281-8839
Mailing address:
  • Phone: 440-506-5674
  • Fax: 440-323-0868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SANRAE J ONYENEKE
Title or Position: PRESIDENT
Credential: LPN
Phone: 216-666-0224