Provider Demographics
NPI:1346338142
Name:POLAND MEDICAL CENTER LTD
Entity Type:Organization
Organization Name:POLAND MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:EVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-707-1425
Mailing Address - Street 1:6615 CLINGAN ROAD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-4202
Mailing Address - Country:US
Mailing Address - Phone:330-707-1425
Mailing Address - Fax:330-757-2814
Practice Address - Street 1:6615 CLINGAN ROAD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-4202
Practice Address - Country:US
Practice Address - Phone:330-707-1425
Practice Address - Fax:330-757-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6418200001Medicare NSC