Healthcare Provider Details

I. General information

NPI: 1336133230
Provider Name (Legal Business Name): VCLEW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 RIVER VALLEY BLVD
LANCASTER OH
43130-1659
US

IV. Provider business mailing address

1201 RIVER VALLEY BLVD
LANCASTER OH
43130-1659
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-2273
  • Fax: 740-687-9059
Mailing address:
  • Phone: 740-687-2273
  • Fax: 740-687-9059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name: TINA MARIE ANDERSON
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 740-687-2273