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411 Court St Portsmouth OH 45662-3932 | |
| (740) 354-6685 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 411 Court St, Portsmouth, Ohio |
| Authorized Official Name and Position | Mary Bailey (CHIEF COMPLIANCE OFFICER) |
| Authorized Official Contact | 7403957930 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
411 Court St Portsmouth OH 45662-3932 Ph: (740) 354-6685 | 411 Court St Portsmouth OH 45662-3932 Ph: (740) 354-6685 |
| NPI Number | 1477814879 |
|---|---|
| Provider Enumeration Date | 06/01/2012 |
| Last Update Date | 12/03/2024 |
| Certification Date | 12/03/2024 |
| Medicare PECOS PAC ID | 4880785773 |
|---|---|
| Medicare Enrollment ID | O20070807000452 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477814879 | NPI | - | NPPES |
| Provider Name | Diana L Burns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598197162 PECOS PAC ID: 6204052863 Enrollment ID: I20140717001320 |
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