1275712879 NPI number — ILONA JUREK MD INC

Table of content: (NPI 1275712879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275712879 NPI number — ILONA JUREK MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ILONA JUREK MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275712879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44001-7303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-244-0010
Provider Business Mailing Address Fax Number:
440-244-0726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 KOLBE RD
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
LORAIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44053-1654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-960-5622
Provider Business Practice Location Address Fax Number:
440-960-1690
Provider Enumeration Date:
10/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
440-988-1009

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35062523 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0871669 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0236248 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com