| Beavertown Clinic Inc | |
|
3017 Wilmington Pike Kettering OH 45429-4169 | |
| (937) 294-2555 | |
| (937) 294-3211 |
| Full Name | Beavertown Clinic Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 3017 Wilmington Pike, Kettering, Ohio |
| Authorized Official Name and Position | Bernard J Rose (PHYSICIAN) |
| Authorized Official Contact | 9372942555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beavertown Clinic Inc 3017 Wilmington Pike Kettering OH 45429-4169 Ph: (937) 294-2555 | Beavertown Clinic Inc 3017 Wilmington Pike Kettering OH 45429-4169 Ph: (937) 294-2555 |
| NPI Number | 1902803703 |
|---|---|
| Provider Enumeration Date | 07/07/2005 |
| Last Update Date | 02/23/2010 |
| Medicare PECOS PAC ID | 9830122761 |
|---|---|
| Medicare Enrollment ID | O20050912001312 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902803703 | NPI | - | NPPES |
| R00609981 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 35052219R (Ohio) | Primary |
| 207Q00000X | Family Medicine | 35058825R (Ohio) | Secondary |
| Provider Name | Bernard J Rose |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1508864042 PECOS PAC ID: 1456475235 Enrollment ID: I20130409000496 |
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