Basic Information
| Provider Information | |||||||||
| NPI: | 1134107279 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LUKE IMMEDIATE CARE CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2195 ALLENTOWN RD | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458051705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192272245 | ||||||||
| FaxNumber: | 4192291573 | ||||||||
| Practice Location | |||||||||
| Address1: | 2195 ALLENTOWN RD | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458051705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192272245 | ||||||||
| FaxNumber: | 4192291573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4192272245 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.