Riverside Community /school Based Health Center | |
320 W. Miami Street De Graff OH 43318-9406 | |
(937) 599-1411 | |
(937) 599-4128 |
Full Name | Riverside Community /school Based Health Center |
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Speciality | Clinic/Center |
Location | 320 W. Miami Street, De Graff, Ohio |
Authorized Official Name and Position | Tara Dawn Bair (CEO) |
Authorized Official Contact | 9375991411 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Riverside Community /school Based Health Center 212 E Columbus Ave Ste 1 Bellefontaine OH 43311-2033 Ph: (937) 599-1411 | Riverside Community /school Based Health Center 320 W. Miami Street De Graff OH 43318-9406 Ph: (937) 599-1411 |
NPI Number | 1447965058 |
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Provider Enumeration Date | 01/18/2023 |
Last Update Date | 10/25/2023 |
Medicare PECOS PAC ID | 8022247469 |
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Medicare Enrollment ID | O20230419000966 |
Identifier | Type | State | Issuer |
---|---|---|---|
1447965058 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Secondary |