| Family Practice Center Of Salem, Inc. | |
|
2370 Southeast Blvd Salem OH 44460-3418 | |
| (330) 332-9961 | |
| (330) 332-3860 |
| Full Name | Family Practice Center Of Salem, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 2370 Southeast Blvd, Salem, Ohio |
| Authorized Official Name and Position | Richard L Banning (PRESIDENT) |
| Authorized Official Contact | 3303329961 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Practice Center Of Salem, Inc. 2370 Southeast Blvd Salem OH 44460-3418 Ph: (330) 332-9961 | Family Practice Center Of Salem, Inc. 2370 Southeast Blvd Salem OH 44460-3418 Ph: (330) 332-9961 |
| NPI Number | 1134251077 |
|---|---|
| Provider Enumeration Date | 03/09/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7719911403 |
|---|---|
| Medicare Enrollment ID | O20050922000118 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134251077 | NPI | - | NPPES |
| 0377597 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 35036040 (Ohio) | Primary |
| Provider Name | Constantine V Economous |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396850269 PECOS PAC ID: 4082746888 Enrollment ID: I20100714000440 |
| Provider Name | Michael J Sevilla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114032901 PECOS PAC ID: 4385727569 Enrollment ID: I20100728000083 |
| Provider Name | Richard Banning |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346355278 PECOS PAC ID: 4385749183 Enrollment ID: I20101102000670 |
| Provider Name | Lorraine M Wonner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518269661 PECOS PAC ID: 6204006083 Enrollment ID: I20110906000135 |
| Provider Name | Joseph J Rousher |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568738193 PECOS PAC ID: 4284959396 Enrollment ID: I20150212001795 |
| Provider Name | Brianne M Bagwell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730435975 PECOS PAC ID: 5597072686 Enrollment ID: I20150922003034 |
| Provider Name | Rachel A Carbon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710473384 PECOS PAC ID: 7214273697 Enrollment ID: I20190104002407 |
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