Provider Demographics
NPI:1316394075
Name:SYL-HAVEN MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:SYL-HAVEN MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-794-1006
Mailing Address - Street 1:106 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1411
Mailing Address - Country:US
Mailing Address - Phone:419-794-1006
Mailing Address - Fax:419-873-6599
Practice Address - Street 1:106 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1411
Practice Address - Country:US
Practice Address - Phone:419-794-1006
Practice Address - Fax:419-873-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty