Provider Demographics
NPI:1417367608
Name:KEY CLINICS, LLC
Entity Type:Organization
Organization Name:KEY CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-775-7440
Mailing Address - Street 1:1284 SOM CENTER RD STE 368
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2048
Mailing Address - Country:US
Mailing Address - Phone:419-775-7440
Mailing Address - Fax:216-916-7779
Practice Address - Street 1:269 PORTLAND WAY SOUTH
Practice Address - Street 2:NORTH LOBBY
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-2312
Practice Address - Country:US
Practice Address - Phone:419-775-7440
Practice Address - Fax:216-916-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1417367608Medicaid
OHH358170Medicare PIN