ERIESIDE MEDICAL GROUP NPI 1891751657

NPI Information

NPI: 1891751657
Provider Name: ERIESIDE MEDICAL GROUP
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 36D0897273

Address:
38429 LAKE SHORE BLVD
WILLOUGHBY, OH
ZIP 44094
Phone: (440) 946-9200
Get Directions

ERIESIDE MEDICAL GROUP is a family medicine in Willoughby, OH. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. ERIESIDE MEDICAL GROUP NPI is 1891751657. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

38429 LAKE SHORE BLVD
WILLOUGHBY, OH
ZIP 44094-009
Phone: (440) 946-9200

The provider's authorized official is Winston Ho .
The authorized official title is President and has the following contact phone number (440) 269-7483.

The CLIA number assigned to this NPI record is 36D0897273 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/21/2006 and was last updated on 6/10/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207R00000X	Internal Medicine		35-06-5285H	OHIO	No
2	207R00000X	Internal Medicine		34-003413F	OHIO	No
3	2080A0000X	Pediatrics	Adolescent Medicine	35-06-1390M		No
4	207Q00000X	Family Medicine		35-052285D	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	F59340	MEDICARE UPIN	OHIO
2	C02730	MEDICARE UPIN	OHIO
3	A16908	MEDICARE UPIN	OHIO
4	F30444	MEDICARE UPIN	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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