Avon Mediclinic,LLC
Organization Active NPI Family Medicine Physician · Elyria, OH
NPI 1962746958 · NPPES record last updated May 20, 2024
Key facts
- NPI
- 1962746958
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- AVON MEDICLINIC,LLC
- Practice address
- 1260 Abbe Rd N
Elyria, OH 44035-1649 - Phone
- (440) 366-0455
- Fax
- (440) 281-8839
- NPI assigned
- Nov 15, 2012
- Organization subpart
- No
Authorized official
- Name
- Sanrae J Onyeneke, LPN
- Title
- President
- Phone
- (440) 506-5674
Practitioners 2
-
Chuka Onyeneke, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D2079033 | Avon Mediclinic | Certificate of waiver | Sep 29, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140129001594 | OH | Part B Supplier - Clinic/Group Practice | 3577790898 |
Receives reassigned benefits from 1 practitioner Practice locations: Elyria, OH |
National Provider Directory
Locations
2100 Center Rd
Avon, OH 44011
Phone (440) 322-6038
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Urgent Care Clinic/Center | 261QU0200X | OH |
Addresses
Primary practice location
1260 Abbe Rd N
Elyria, OH 44035-1649
Mailing address
1260 Abbe Rd N
Elyria, OH 44035-1649
Phone (440) 366-0455
Other practice location 1
2100 Center Rd
Avon, OH 44011-1891
Phone (440) 506-5674
Other providers in Elyria, OH
- Megan Lee Ashenfleur
- Ramez Mohammad Assad
- Emad Atalla
- Jackie Atkinson
- Brian J Aulisio
- Kasia Malane Babics
- Justin Edward Bacon
- Emma Rose Bacsi
- Brooke Ann Bader
- Kimberly M Bair
All providers in Elyria, 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 May 20, 2024. 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.