| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 412 Main St, Delta, Ohio |
| Authorized Official Name and Position | Lora Meyers (OWNER) |
| Authorized Official Contact | 4198525667 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
104 Pennsylvania Ave Swanton OH 43558-1336 Ph: (419) 852-5667 | 412 Main St Delta OH 43515-1315 Ph: (419) 779-3885 |
| NPI Number | 1215650148 |
|---|---|
| Provider Enumeration Date | 09/26/2022 |
| Last Update Date | 09/14/2023 |
| Certification Date | 09/14/2023 |
| Medicare PECOS PAC ID | 2668835851 |
|---|---|
| Medicare Enrollment ID | O20230906001869 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215650148 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lora K Meyers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376049106 PECOS PAC ID: 9830587997 Enrollment ID: I20211022002073 |