MEDICARE: ON DEMAND IMMEDIATE CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629468061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON DEMAND IMMEDIATE CARE, LLC

Provider Business Mailing Address
First Line	:	5760 PATRIOT DRIVE
Second Line	:	SUITE D
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-1170
Country	:	US
Telephone Number	:	330-270-3660
Fax Number	:

Provider Business Practice Location Address
First Line	:	5760 PATRIOT DRIVE
Second Line	:	SUITE B
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-1170
Country	:	US
Telephone Number	:	330-270-3660
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS R. IVANY
Credential	:
Telephone Number	:	330-270-3660

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	01/20/2025

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