MEDICARE: LORAIN COUNTY HEALTH & DENTISTRY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207QA0505X	Adult Medicine Physician
3	207R00000X	Internal Medicine Physician
4	207V00000X	Obstetrics & Gynecology Physician
5	208000000X	Pediatrics Physician
6	213E00000X	Podiatrist
7	363LP0200X	Pediatric Nurse Practitioner
8	363LP2300X	Primary Care Nurse Practitioner
9	261QF0400X	Federally Qualified Health Center (FQHC)

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	:	1891030128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORAIN COUNTY HEALTH & DENTISTRY

Provider Business Mailing Address
First Line	:	1205 BROADWAY
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44052-3409
Country	:	US
Telephone Number	:	440-240-1655
Fax Number	:	440-245-1218

Provider Business Practice Location Address
First Line	:	801 MIDDLE AVE
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-5850
Country	:	US
Telephone Number	:	440-240-1655
Fax Number	:	440-240-1663

Authorized Official
Title or Position	:	CFO
Name	:	LISA M. HEMKER
Credential	:
Telephone Number	:	440-240-1655

Provider Enumeration Date	:	11/27/2012
Last Update Date	:	06/24/2021

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Directions to “LORAIN COUNTY HEALTH & DENTISTRY ” Practice Location

Language	Start Address	Practice Location

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