Provider Demographics
NPI:1962746958
Name:AVON MEDICLINIC,LLC
Entity type:Organization
Organization Name:AVON MEDICLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANRAE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ONYENEKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:440-506-5674
Mailing Address - Street 1:1260 ABBE RD N
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1649
Mailing Address - Country:US
Mailing Address - Phone:440-366-0455
Mailing Address - Fax:440-281-8839
Practice Address - Street 1:1260 ABBE RD N
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1649
Practice Address - Country:US
Practice Address - Phone:440-366-0455
Practice Address - Fax:440-281-8839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
OH261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty