MEDICARE: URBAN HEALTH CENTER 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1881922425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URBAN HEALTH CENTER LLC

Provider Business Mailing Address
First Line	:	5600 IRONWOOD CT APT C
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-4360
Country	:	US
Telephone Number	:	614-854-0698
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 IRONWOOD CT APT C
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-4360
Country	:	US
Telephone Number	:	614-854-0698
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MR. ED MANO
Credential	:
Telephone Number	:	614-854-0698

Provider Enumeration Date	:	11/19/2009
Last Update Date	:	11/19/2009

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