Healthcare Provider Details

I. General information

NPI: 1467517136
Provider Name (Legal Business Name): ELYRIA MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2006
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CLEVELAND ST
ELYRIA OH
44035-6155
US

IV. Provider business mailing address

160 CLEVELAND ST
ELYRIA OH
44035-6155
US

V. Phone/Fax

Practice location:
  • Phone: 440-322-6032
  • Fax: 440-323-0868
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number65855
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number65855
License Number StateOH

VIII. Authorized Official

Name: DR. CHUKA ONYENEKE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 440-322-6032