E. A. Dechellis, D.o., Inc. | |
3002 State Route 5 Ste B Cortland OH 44410-9202 | |
(330) 637-1000 | |
(330) 637-9905 |
Full Name | E. A. Dechellis, D.o., Inc. |
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Speciality | Family Medicine |
Location | 3002 State Route 5 Ste B, Cortland, Ohio |
Authorized Official Name and Position | Ernest A Dechellis (OWNER) |
Authorized Official Contact | 3306371000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
E. A. Dechellis, D.o., Inc. 3002 State Route 5 Ste B Cortland OH 44410-9202 Ph: (330) 637-1000 | E. A. Dechellis, D.o., Inc. 3002 State Route 5 Ste B Cortland OH 44410-9202 Ph: (330) 637-1000 |
NPI Number | 1720365430 |
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Provider Enumeration Date | 11/09/2011 |
Last Update Date | 11/09/2011 |
Medicare PECOS PAC ID | 5294900783 |
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Medicare Enrollment ID | O20111212000693 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720365430 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 4006 (Ohio) | Primary |
Provider Name | Ernest A Dechellis |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1821040064 PECOS PAC ID: 7810162302 Enrollment ID: I20111212000725 |
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