| Eastside Internal Medicine-geriatrics, Inc | |
|
1001 W Main St Williamsburg OH 45176-1146 | |
| (513) 724-2226 | |
| (513) 724-5248 |
| Full Name | Eastside Internal Medicine-geriatrics, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1001 W Main St, Williamsburg, Ohio |
| Authorized Official Name and Position | Jyoti J Mehta (PRESIDENT) |
| Authorized Official Contact | 5137242226 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastside Internal Medicine-geriatrics, Inc Po Box 643113 Cincinnati OH 45264-0307 Ph: (513) 724-2226 | Eastside Internal Medicine-geriatrics, Inc 1001 W Main St Williamsburg OH 45176-1146 Ph: (513) 724-2226 |
| NPI Number | 1083684112 |
|---|---|
| Provider Enumeration Date | 01/23/2006 |
| Last Update Date | 03/25/2010 |
| Medicare PECOS PAC ID | 4183658735 |
|---|---|
| Medicare Enrollment ID | O20100318000941 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083684112 | NPI | - | NPPES |
| DO8367 | Other | OH | RR MCR |
| 3007721 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Jyoti Mehta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932170933 PECOS PAC ID: 2163456716 Enrollment ID: I20100318000929 |
| Provider Name | Kathy S Brock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154695641 PECOS PAC ID: 5698935609 Enrollment ID: I20120329000206 |
| Provider Name | Melody Sue King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518493683 PECOS PAC ID: 1557631298 Enrollment ID: I20170727003592 |
Healthsource: Williamsburg Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 500 S 5th St Ste 202, Williamsburg, OH 45176 Phone: 513-732-5086 Fax: 513-436-0470 | |
Healthsource: Williamsburg Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 500 S 5th St Ste 202, Williamsburg, OH 45176 Phone: 513-732-5086 Fax: 513-436-0470 |