| Longevity Clinical Ltc Associates Of Ohio, Inc. | |
|
12380 Plaza Dr Parma OH 44130-1043 | |
| (216) 898-8399 | |
| Not Available |
| Full Name | Longevity Clinical Ltc Associates Of Ohio, Inc. |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 12380 Plaza Dr, Parma, Ohio |
| Authorized Official Name and Position | Diane L Vincur (PRACTICE MANAGER) |
| Authorized Official Contact | 5618152427 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longevity Clinical Ltc Associates Of Ohio, Inc. 11780 Us Highway 1 Ste N107 North Palm Beach FL 33408-3007 Ph: (561) 815-2427 | Longevity Clinical Ltc Associates Of Ohio, Inc. 12380 Plaza Dr Parma OH 44130-1043 Ph: (216) 898-8399 |
| NPI Number | 1114609815 |
|---|---|
| Provider Enumeration Date | 08/02/2023 |
| Last Update Date | 08/02/2023 |
| Medicare PECOS PAC ID | 3072960764 |
|---|---|
| Medicare Enrollment ID | O20231117001524 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114609815 | NPI | - | NPPES |
| Provider Name | Michelle Kelly-daum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912095951 PECOS PAC ID: 3173600368 Enrollment ID: I20080412000052 |
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