Healthcare Provider Details

I. General information

NPI: 1104115427
Provider Name (Legal Business Name): NORTH OLMSTED URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 12/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25757 LORAIN RD
NORTH OLMSTED OH
44070-3370
US

IV. Provider business mailing address

PO BOX 770920
LAKEWOOD OH
44107-0041
US

V. Phone/Fax

Practice location:
  • Phone: 440-471-7083
  • Fax: 440-471-7113
Mailing address:
  • Phone: 440-471-7083
  • Fax: 440-471-7113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34009045
License Number StateOH

VIII. Authorized Official

Name: DR. NICOLAS A YOUNG
Title or Position: OWNER
Credential: DO
Phone: 440-471-7083