| Center Street Community Clinic, Inc | |
|
125 Executive Dr Ste 201 Marion OH 43302-6302 | |
| (740) 387-3087 | |
| Not Available |
| Full Name | Center Street Community Clinic, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 125 Executive Dr Ste 201, Marion, Ohio |
| Authorized Official Name and Position | Audrey Cobb (CFO) |
| Authorized Official Contact | 7407514531 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center Street Community Clinic, Inc 136 W Center St Marion OH 43302-3704 Ph: (740) 751-4531 | Center Street Community Clinic, Inc 125 Executive Dr Ste 201 Marion OH 43302-6302 Ph: (740) 387-3087 |
| NPI Number | 1306627476 |
|---|---|
| Provider Enumeration Date | 10/13/2023 |
| Last Update Date | 12/22/2023 |
| Medicare PECOS PAC ID | 7012815210 |
|---|---|
| Medicare Enrollment ID | O20240201001070 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306627476 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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Center Street Community Clinic Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 205 West Center Street, Suite 200, Marion, OH 43302 Phone: 740-375-6030 Fax: 740-382-8291 | |
Center Street Community Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 205 W Center St, Suite 200, Marion, OH 43302 Phone: 740-751-4189 Fax: 740-751-4866 |