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General NPI Number Information
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NPI Number | 1346338142
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Entity Type | Organization
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Legal Business Name | POLAND MEDICAL CENTER LTD
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 6615 CLINGAN ROAD
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City | POLAND
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State | OH
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Zip | 44514-4202
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Country | US
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Telephone | 330-707-1425
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Fax | 330-757-2814
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Provider Business Mailing Address
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Address Line | 6615 CLINGAN ROAD
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City | POLAND
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State | OH
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Zip | 44514-4202
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Country | US
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Telephone | 330-707-1425
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Fax | 330-757-2814
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL B EVAN
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Credential | MD
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Telephone | 330-707-1425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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