Provider Demographics
NPI:1205829082
Name:HARBOR MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:HARBOR MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-964-0616
Mailing Address - Street 1:611 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-3262
Mailing Address - Country:US
Mailing Address - Phone:440-964-0616
Mailing Address - Fax:440-964-3703
Practice Address - Street 1:611 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3262
Practice Address - Country:US
Practice Address - Phone:440-964-0616
Practice Address - Fax:440-964-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3001834Medicaid
OH3001834Medicaid
OH3001834Medicaid
OH9345381Medicare PIN