Provider Demographics
NPI:1871571091
Name:NORDONIA HILLS CLINIC INC
Entity type:Organization
Organization Name:NORDONIA HILLS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:KITHCART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-467-8101
Mailing Address - Street 1:7689 SAGAMORE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2960
Mailing Address - Country:US
Mailing Address - Phone:330-467-8101
Mailing Address - Fax:330-468-3911
Practice Address - Street 1:7689 SAGAMORE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:SAGAMORE HILLS
Practice Address - State:OH
Practice Address - Zip Code:44067-2960
Practice Address - Country:US
Practice Address - Phone:330-467-8101
Practice Address - Fax:330-468-3948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0125457Medicaid
OH0125457Medicaid