Healthcare Provider Details

I. General information

NPI: 1346338142
Provider Name (Legal Business Name): POLAND MEDICAL CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 CLINGAN ROAD
POLAND OH
44514-4202
US

IV. Provider business mailing address

6615 CLINGAN ROAD
POLAND OH
44514-4202
US

V. Phone/Fax

Practice location:
  • Phone: 330-707-1425
  • Fax: 330-757-2814
Mailing address:
  • Phone: 330-707-1425
  • Fax: 330-757-2814

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 Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL B EVAN
Title or Position: PRESIDENT
Credential: MD
Phone: 330-707-1425