Provider Demographics
NPI:1629468061
Name:ON DEMAND IMMEDIATE CARE, LLC
Entity Type:Organization
Organization Name:ON DEMAND IMMEDIATE CARE, LLC
Other - Org Name:ON DEMAND PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:IVANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-270-3660
Mailing Address - Street 1:5760 PATRIOT DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-1170
Mailing Address - Country:US
Mailing Address - Phone:330-270-3660
Mailing Address - Fax:
Practice Address - Street 1:5760 PATRIOT DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-1170
Practice Address - Country:US
Practice Address - Phone:330-270-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0205041Medicaid