Organization
OM HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHY DARLENE BECKER (OFFICE MANAGER)
(440) 326-4355
Entity
Organization
Contact information
Practice address
125 E BROAD ST, STE 215, ELYRIA, OH 44035
(440) 329-7305
(440) 329-7798
Mailing address
125 E BROAD ST, STE 202, ELYRIA, OH 44035
(440) 329-7305
(440) 329-7798
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09328932
MEDICARE STE 215
OH
05
—
2348963
—
OH
Enumeration date
08/11/2005
Last updated
07/21/2022
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