| Caa East Liverpool Campus Bldg 2 | |
|
16494 Saint Clair Ave East Liverpool OH 43920-9142 | |
| (330) 424-7221 | |
| Not Available |
| Full Name | Caa East Liverpool Campus Bldg 2 |
|---|---|
| Speciality | Clinic/Center |
| Location | 16494 Saint Clair Ave, East Liverpool, Ohio |
| Authorized Official Name and Position | Jenna Wonner (COO) |
| Authorized Official Contact | 3304247221 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Caa East Liverpool Campus Bldg 2 7880 Lincole Pl Lisbon OH 44432-8322 Ph: (330) 424-7221 | Caa East Liverpool Campus Bldg 2 16494 Saint Clair Ave East Liverpool OH 43920-9142 Ph: (330) 424-7221 |
| NPI Number | 1841780863 |
|---|---|
| Provider Enumeration Date | 05/15/2018 |
| Last Update Date | 09/11/2020 |
| Medicare PECOS PAC ID | 8123928645 |
|---|---|
| Medicare Enrollment ID | O20181025001346 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841780863 | NPI | - | NPPES |
| 0346422 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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