Organization
FORUM HEALTH SERVICES
Active
Other names
Elm Road Immediate Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY J NIEMI M.D. (MEDICAL DIRECTOR)
(330) 841-3004
Entity
Organization
Contact information
Practice address
2662 ELM RD NE, CORTLAND, OH 44410-9393
(330) 841-3004
Mailing address
2662 ELM RD NE, CORTLAND, OH 44410-9393
(330) 841-3004
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000165909
ANTHEM GROUP NUMBER
OH
01
—
1525808
GATEWAY GROUP NUMBER
OH
05
—
2179913
—
OH
01
—
6600170
UHC PROV NUMBER
OH
01
—
7997187
AETNA GROUP NUMBER
OH
01
—
94930
QUALCHOICE NUMBER
OH
Enumeration date
06/10/2006
Last updated
08/22/2020
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