| Eastside Primary Care LLC | |
|
36100 Euclid Ave #430 Willoughby OH 44094-4456 | |
| (440) 946-4070 | |
| (440) 946-4071 |
| Full Name | Eastside Primary Care LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 36100 Euclid Ave, Willoughby, Ohio |
| Authorized Official Name and Position | Jean B Lenk (OWNER) |
| Authorized Official Contact | 4409464070 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastside Primary Care LLC Po Box 22958 Cleveland OH 44122-0958 Ph: (216) 595-9600 | Eastside Primary Care LLC 36100 Euclid Ave #430 Willoughby OH 44094-4456 Ph: (440) 946-4070 |
| NPI Number | 1922308774 |
|---|---|
| Provider Enumeration Date | 10/27/2010 |
| Last Update Date | 05/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922308774 | NPI | - | NPPES |
| 0819663 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Ohio) | Primary |
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