Provider Demographics
NPI:1194299198
Name:ON DEMAND COUNSELING LAB
Entity type:Organization
Organization Name:ON DEMAND COUNSELING LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:IVANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-270-3660
Mailing Address - Street 1:102 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3963
Mailing Address - Country:US
Mailing Address - Phone:330-270-3660
Mailing Address - Fax:330-270-2690
Practice Address - Street 1:5760 PATRIOT BLVD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515
Practice Address - Country:US
Practice Address - Phone:330-270-3660
Practice Address - Fax:330-270-2690
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ON DEMAND COUNSELING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0246535Medicaid