Daniel R Black, DO | |
100 Jackson Pike, Gallipolis, OH 45631-1560 | |
(740) 446-5401 | |
(740) 446-5408 |
Full Name | Daniel R Black |
---|---|
Gender | Male |
Speciality | Physical Medicine & Rehabilitation |
Location | 100 Jackson Pike, Gallipolis, Ohio |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1598719882 | NPI | - | NPPES |
0113223000 | Medicaid | WV | |
0749373 | Medicaid | OH | |
200013580 | Other | RR MEDICARE | |
000000006573 | Other | ANTHEM BCBS | |
001714051 | Other | MOUNTAIN STATE BCBS | |
310917085122 | Other | OH | CARESOURCE MEDICAID |
000000185253 | Other | OH | UNISON MEDICAID |
0749373 | Other | OH | MOLINA MEDICAID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208100000X | Physical Medicine & Rehabilitation | 34-00-4704 (Ohio) | Primary |
Entity Name | Holzer Clinic Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1508817248 PECOS PAC ID: 5890606008 Enrollment ID: O20031215000746 |
Mailing Address | Practice Location Address |
---|---|
Daniel R Black, DO 90 Jackson Pike, Gallipolis, OH 45631-1560 Ph: (740) 446-5401 | Daniel R Black, DO 100 Jackson Pike, Gallipolis, OH 45631-1560 Ph: (740) 446-5401 |
Shailen K. Mehta, M.D. Physical Medicine & Rehabilitation Medicare: Not Enrolled in Medicare Practice Location: 90 Jackson Pike, Gallipolis, OH 45631 Phone: 740-441-8070 Fax: 740-446-5408 | |
Dr. Corey Allen Johnson, D.O. Physical Medicine & Rehabilitation Medicare: Accepting Medicare Assignments Practice Location: 100 Jackson Pike, Gallipolis, OH 45631 Phone: 855-446-5937 Fax: 740-446-5408 |