Provider Demographics
NPI:1629033550
Name:AIRPORT URGENT CARE & MEDICAL CENTE
Entity Type:Organization
Organization Name:AIRPORT URGENT CARE & MEDICAL CENTE
Other - Org Name:AIRPORT URGENT CARE & MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BONVENTURE
Authorized Official - Middle Name:
Authorized Official - Last Name:OKORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-865-6522
Mailing Address - Street 1:5542 AIRPORT HWY
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7304
Mailing Address - Country:US
Mailing Address - Phone:419-865-6522
Mailing Address - Fax:419-865-6523
Practice Address - Street 1:5542 AIRPORT HWY
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7304
Practice Address - Country:US
Practice Address - Phone:419-865-6522
Practice Address - Fax:419-865-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-055690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty