| Gregory Sasarak Inc | |
|
280 S Logan St Elyria OH 44035-6224 | |
| (440) 365-9311 | |
| (440) 366-5057 |
| Full Name | Gregory Sasarak Inc |
|---|---|
| Speciality | Clinic/center |
| Location | 280 S Logan St, Elyria, Ohio |
| Authorized Official Name and Position | Gregory S Sasarak (OWNER) |
| Authorized Official Contact | 4403659311 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gregory Sasarak Inc 280 S Logan St Elyria OH 44035-6224 Ph: (440) 365-9311 | Gregory Sasarak Inc 280 S Logan St Elyria OH 44035-6224 Ph: (440) 365-9311 |
| NPI Number | 1710239991 |
|---|---|
| Provider Enumeration Date | 10/11/2012 |
| Last Update Date | 10/30/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710239991 | NPI | - | NPPES |
| 2642840 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 5592 (Ohio) | Primary |
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