Healthcare Provider Details

I. General information

NPI: 1497801237
Provider Name (Legal Business Name): WOOSTER CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 E MILLTOWN RD
WOOSTER OH
44691-1255
US

IV. Provider business mailing address

6801 BRECKSVILLE RD STE 20, ATTN: DPC RK2-7
INDEPENDENCE OH
44131-5062
US

V. Phone/Fax

Practice location:
  • Phone: 330-287-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0705AS
License Number StateOH

VIII. Authorized Official

Name: DENNIS LARAWAY
Title or Position: EXECUTIVE VP CHIEF FINANCE OFFICER
Credential:
Phone: 216-445-1343