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General NPI Number Information
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NPI Number | 1588764864
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Entity Type | Organization
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Legal Business Name | CITY OF ELYRIA
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | 202 CHESTNUT ST
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City | ELYRIA
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State | OH
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Zip | 44035-5325
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Country | US
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Telephone | 440-323-7595
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Fax | 440-284-1558
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Provider Business Mailing Address
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Address Line | 202 CHESTNUT ST
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City | ELYRIA
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State | OH
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Zip | 44035-5325
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Country | US
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Telephone | 440-323-7595
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Fax | 440-284-1558
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DOUGLAS G MCDONALD
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Credential | M.D.
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Telephone | 440-323-7595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 020261600
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License Number State | OH
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