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29 Kyle Dr Cedarville OH 45314-9580 | |
(937) 766-2611 | |
(937) 766-5558 |
Full Name | |
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Speciality | Clinic/Center |
Location | 29 Kyle Dr, Cedarville, Ohio |
Authorized Official Name and Position | Timothy Ko (NETWORK CFO) |
Authorized Official Contact | 9373958522 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2110 Leiter Rd Miamisburg OH 45342-3598 Ph: () - | 29 Kyle Dr Cedarville OH 45314-9580 Ph: (937) 766-2611 |
NPI Number | 1073948774 |
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Provider Enumeration Date | 09/12/2013 |
Last Update Date | 11/25/2024 |
Medicare PECOS PAC ID | 3971406539 |
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Medicare Enrollment ID | O20150331000777 |
Identifier | Type | State | Issuer |
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1073948774 | NPI | - | NPPES |
0146442 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |