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General NPI Number Information
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NPI Number | 1104115427
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Entity Type | Organization
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Legal Business Name | NORTH OLMSTED URGENT CARE, LLC
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 12/11/2016
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Provider Practice Location Address
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Address Line | 25757 LORAIN RD
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3370
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Country | US
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Telephone | 440-471-7083
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Fax | 440-471-7113
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Provider Business Mailing Address
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Address Line | PO BOX 770920
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City | LAKEWOOD
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State | OH
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Zip | 44107-0041
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Country | US
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Telephone | 440-471-7083
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Fax | 440-471-7113
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICOLAS A YOUNG
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Credential | DO
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Telephone | 440-471-7083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34009045
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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