Provider Demographics
NPI:1235436189
Name:TERRA NOVA MEDICAL CLINIC
Entity Type:Organization
Organization Name:TERRA NOVA MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IYABO
Authorized Official - Middle Name:A
Authorized Official - Last Name:IBOAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-424-0815
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45839-0525
Mailing Address - Country:US
Mailing Address - Phone:419-424-0815
Mailing Address - Fax:419-424-1405
Practice Address - Street 1:655 FOX RUN RD STE E
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-8401
Practice Address - Country:US
Practice Address - Phone:419-424-0815
Practice Address - Fax:419-424-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.92245261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center