LAKE COUNTY FREE MEDICAL CLINIC NPI 1730397282

NPI Information

NPI: 1730397282
Provider Name: LAKE COUNTY FREE MEDICAL CLINIC

Former Legal Business Name: FREE CLINIC OF LAKE COUNTY

Classification: Voluntary or Charitable - 251V00000X
Entity Type: Organization

Address:
54 S STATE ST
SUITE 302
PAINESVILLE, OH
ZIP 44077
Phone: (440) 352-8686
Get Directions

LAKE COUNTY FREE MEDICAL CLINIC is a voluntary or charitable in Painesville, OH. LAKE COUNTY FREE MEDICAL CLINIC NPI is 1730397282. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Free Clinic Of Lake County.

The provider's business location address is:

54 S STATE ST
SUITE 302
PAINESVILLE, OH
ZIP 44077-445
Phone: (440) 352-8686
Fax: (440) 352-8107

The provider's authorized official is Annatonia K Fetzer .
The authorized official title is Executive Director and has the following contact phone number (440) 352-8686.

The CLIA number assigned to this NPI record is 36D0334775 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/18/2007 and was last updated on 12/11/2007.

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	251V00000X	Voluntary or Charitable				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	Other Provider Identifier Issuer
1	0716416	MEDICAID	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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