Healthcare Provider Details

I. General information

NPI: 1780463794
Provider Name (Legal Business Name): SLB MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MERZ BLVD STE D
FAIRLAWN OH
44333-3629
US

IV. Provider business mailing address

34 MERZ BLVD STE D
FAIRLAWN OH
44333-3629
US

V. Phone/Fax

Practice location:
  • Phone: 234-529-4700
  • Fax:
Mailing address:
  • Phone: 234-529-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW LEMMON
Title or Position: CEO
Credential:
Phone: 330-464-8281