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General NPI Number Information
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NPI Number | 1639413453
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Entity Type | Organization
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Legal Business Name | ELYRIA MEDICLINIC
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 1260 ABBE RD N
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City | ELYRIA
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State | OH
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Zip | 44035-1649
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Country | US
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Telephone | 440-366-0455
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Fax | 440-281-8839
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Provider Business Mailing Address
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Address Line | 156 CLEVELAND STREET
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City | ELYRIA
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State | OH
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Zip | 44035
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Country | US
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Telephone | 440-506-5674
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Fax | 440-323-0868
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SANRAE J ONYENEKE
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Credential | LPN
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Telephone | 216-666-0224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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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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