Provider Demographics
NPI:1427085273
Name:V CLEW, LLC
Entity type:Organization
Organization Name:V CLEW, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-687-2273
Mailing Address - Street 1:1201 RIVER VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1659
Mailing Address - Country:US
Mailing Address - Phone:740-687-2273
Mailing Address - Fax:740-687-9059
Practice Address - Street 1:1201 RIVER VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1659
Practice Address - Country:US
Practice Address - Phone:740-687-2273
Practice Address - Fax:740-687-9059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1472340261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHVC9346191OtherMEDICARE
OH02-1472800OtherOHIO FACILITY PHARMACY LI
OH36D03280453OtherCLIA ID NUMBER
OH980524OtherOBWC NUMBER
OH10E0884201OtherODH RADIATION LICENSE
OH02-1472800OtherOHIO FACILITY PHARMACY LI