Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 110 West Main St, Freeport, Ohio |
Authorized Official Name and Position | Jeffrey Britton (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 7402396447 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
110 West Main St Freeport OH 43973 Ph: (740) 658-3329 | 110 West Main St Freeport OH 43973 Ph: (740) 658-3329 |
NPI Number | 1275579484 |
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Provider Enumeration Date | 06/22/2006 |
Last Update Date | 11/03/2021 |
Medicare PECOS PAC ID | 7113990177 |
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Medicare Enrollment ID | O20080207000294 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275579484 | NPI | - | NPPES |
OH3618281 | Other | OH | MEDICAE FQHC PIN |
0824246 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |