| Diethra D. Cox, M.d., Inc. | |
|
9485 Mentor Ave Suite 203 Mentor OH 44060-4597 | |
| (440) 205-0242 | |
| Not Available |
| Full Name | Diethra D. Cox, M.d., Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 9485 Mentor Ave, Mentor, Ohio |
| Authorized Official Name and Position | Diethra D. Cox (PRESIDENT) |
| Authorized Official Contact | 4402050242 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diethra D. Cox, M.d., Inc. 9485 Mentor Ave Suite 203 Mentor OH 44060-4597 Ph: (440) 205-0242 | Diethra D. Cox, M.d., Inc. 9485 Mentor Ave Suite 203 Mentor OH 44060-4597 Ph: (440) 205-0242 |
| NPI Number | 1740325240 |
|---|---|
| Provider Enumeration Date | 02/21/2007 |
| Last Update Date | 02/25/2011 |
| Medicare PECOS PAC ID | 6800094608 |
|---|---|
| Medicare Enrollment ID | O20210430000585 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740325240 | NPI | - | NPPES |
| 0702789 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 35-05-4360-C (Ohio) | Primary |
| Provider Name | Diethra Diane Cox |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1790796274 PECOS PAC ID: 3870488315 Enrollment ID: I20040216000438 |
| Provider Name | Sarah Jean Small |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578948824 PECOS PAC ID: 1759699853 Enrollment ID: I20151008001914 |
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