Provider Demographics
NPI:1215526934
Name:CRU CLINIC
Entity type:Organization
Organization Name:CRU CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWISHER
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:419-989-3180
Mailing Address - Street 1:2293 VILLAGE PARK CT
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1167
Mailing Address - Country:US
Mailing Address - Phone:419-775-5457
Mailing Address - Fax:866-500-5148
Practice Address - Street 1:2293 VILLAGE PARK CT
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1167
Practice Address - Country:US
Practice Address - Phone:419-775-5457
Practice Address - Fax:866-500-5148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-17
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0412012Medicaid