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3601 Gender Rd Canal Winchester OH 43110-9739 | |
(614) 235-5555 | |
(614) 536-1994 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3601 Gender Rd, Canal Winchester, Ohio |
Authorized Official Name and Position | Yammah Morgan (CHIEF OPERATING OFFICER) |
Authorized Official Contact | 6142355555 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 632127 Cincinnati OH 45263-3003 Ph: (614) 235-5555 | 3601 Gender Rd Canal Winchester OH 43110-9739 Ph: (614) 235-5555 |
NPI Number | 1578083234 |
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Provider Enumeration Date | 06/23/2017 |
Last Update Date | 10/31/2023 |
Medicare PECOS PAC ID | 7416039839 |
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Medicare Enrollment ID | O20171108000447 |
Identifier | Type | State | Issuer |
---|---|---|---|
1578083234 | NPI | - | NPPES |
2913066 | Medicaid | OH | |
0265791 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Ohio) | Primary |
Diley Medical Group Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 7901 Diley Rd Ste 260, Canal Winchester, OH 43110 Phone: 614-920-1000 Fax: 614-920-1007 | |
Assisted Living Medical Providers Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7901 Diley Rd, Suite 260, Canal Winchester, OH 43110 Phone: 614-834-3764 Fax: 614-417-1438 | |