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29804 Lake Shore Blvd Willowick OH 44095-4611 | |
(440) 585-3322 | |
(440) 585-1962 |
Full Name | |
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Speciality | Clinic/center - Urgent Care |
Location | 29804 Lake Shore Blvd, Willowick, Ohio |
Authorized Official Name and Position | Bob Tracz (CFO) |
Authorized Official Contact | 4403541953 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 781348 Detroit MI 48278-1348 Ph: (800) 354-1895 | 29804 Lake Shore Blvd Willowick OH 44095-4611 Ph: (440) 585-3322 |
NPI Number | 1912967209 |
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Provider Enumeration Date | 03/23/2006 |
Last Update Date | 02/15/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912967209 | NPI | - | NPPES |
264200001 | Other | OH | DEPT OF LABOR |
80507 | Other | OH | QUALCHOICE |
2017301 | Medicaid | OH | |
264200001 | Other | OH | FEDERAL BLACK LUNG |
6600162 | Other | OH | UNITED HEALTHCARE |
2440148 | Medicaid | OH |