Healthcare Provider Details

I. General information

NPI: 1871571091
Provider Name (Legal Business Name): NORDONIA HILLS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7689 SAGAMORE HILLS BLVD
SAGAMORE HILLS OH
44067-2960
US

IV. Provider business mailing address

7689 SAGAMORE HILLS BLVD
SAGAMORE HILLS OH
44067-2960
US

V. Phone/Fax

Practice location:
  • Phone: 330-467-8101
  • Fax: 330-468-3948
Mailing address:
  • Phone: 330-467-8101
  • Fax: 330-468-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: W SUE KITHCART
Title or Position: ADMINISTRATOR
Credential:
Phone: 330-467-8101