Poland Medical Center LTD
Organization Active NPI Family Medicine Physician · Poland, OH
NPI 1346338142 · NPPES record last updated Mar 16, 2023
Key facts
- NPI
- 1346338142
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- POLAND MEDICAL CENTER LTD
- Practice address
- 6615 Clingan Road
Poland, OH 44514-4202 - Phone
- (330) 707-1425
- Fax
- (330) 757-2814
- NPI assigned
- Oct 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Michael B Evan, MD
- Title
- President
- Phone
- (330) 707-1425
Member organizations 1
Practitioners 12
-
Michael Bogan Evan, M.D.
-
Kelli Becker, APRN-CNP
-
Michael Lane Black, M.D.
-
Arthur W Duran, DO
-
Matthew Guy Gugliotti, M.D.
-
Sandy P Naples, DO
-
Nino C Rubino, MD
-
Joseph Petrolla, PA-C
-
Michael M Malmer, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D0669289 | Poland Medical Center | Certificate of waiver | Dec 22, 2027 |
| 36D0720794 | Poland Medical Center | Certificate of waiver | Dec 27, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061205000006 | OH | Part B Supplier - Clinic/Group Practice | 3678572559 |
Receives reassigned benefits from 11 practitioners Practice locations: Poland, OH |
| O20100930012258 | OH | DME Supplier - Physician - Family Practice | 3678572559 | Practice locations: Poland, OH |
National Provider Directory
Locations
1044 Belmont Ave
#6S
Youngstown, OH 44504
6615 Clingan Rd
Ste C
Youngstown, OH 44514
Phone (330) 757-7888
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Primary Care Clinic/Center | 261QP2300X |
Addresses
Primary practice location
6615 Clingan Road
Poland, OH 44514-4202
Mailing address
6615 Clingan Road
Poland, OH 44514-4202
Phone (330) 707-1425
NPI Registry JSON
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1678924800000",
"number": "1346338142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6615 CLINGAN ROAD",
"city": "POLAND",
"state": "OH",
"postal_code": "445144202",
"telephone_number": "330-707-1425",
"fax_number": "330-757-2814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6615 CLINGAN ROAD",
"city": "POLAND",
"state": "OH",
"postal_code": "445144202",
"telephone_number": "330-707-1425",
"fax_number": "330-757-2814"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "POLAND MEDICAL CENTER LTD",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-10",
"last_updated": "2023-03-16",
"certification_date": "2023-03-16",
"status": "A",
"authorized_official_last_name": "EVAN",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "B",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "330-707-1425",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poland, OH
- Poland Chiropractic Clinic LLC
- Poland Eye and Laser Center, LLC
- Poland Family Chiropractic, Inc.
- Poland Imaging
- Poland Local SD
- Poland Way Assisted Living, LLC
- Jenny Potter
- Preferred Care Counseling LLC
- Preferred Care Counseling LLC
- Preferred Prosthetics and Orthotics, Inc.
All providers in Poland, OH · Family Medicine Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.