| Center Street Community Clinic, Inc | |
|
125 Executive Dr Ste 201 Marion OH 43302-6302 | |
| (740) 387-3087 | |
| Not Available |
| Full Name | Center Street Community Clinic, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 125 Executive Dr Ste 201, Marion, Ohio |
| Authorized Official Name and Position | Audrey Cobb (CFO) |
| Authorized Official Contact | 7407514531 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center Street Community Clinic, Inc 136 W Center St Marion OH 43302-3704 Ph: (740) 751-4531 | Center Street Community Clinic, Inc 125 Executive Dr Ste 201 Marion OH 43302-6302 Ph: (740) 387-3087 |
| NPI Number | 1609657766 |
|---|---|
| Provider Enumeration Date | 10/13/2023 |
| Last Update Date | 10/13/2023 |
| Certification Date | 10/13/2023 |
| Medicare PECOS PAC ID | 7012815210 |
|---|---|
| Medicare Enrollment ID | O20241023004690 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609657766 | NPI | - | NPPES |
| Provider Name | Joseph T Spare |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548238298 PECOS PAC ID: 7113967654 Enrollment ID: I20050504000754 |
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