| Hicksfamilymedicineohio, Llc | |
|
102 W Ash St Continental OH 45831-9162 | |
| (561) 305-9856 | |
| Not Available |
| Full Name | Hicksfamilymedicineohio, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 102 W Ash St, Continental, Ohio |
| Authorized Official Name and Position | Stacie Hicks (PRESIDENT/OWNER) |
| Authorized Official Contact | 5613059856 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hicksfamilymedicineohio, Llc 102 W Ash St Continental OH 45831-9162 Ph: (561) 305-9856 | Hicksfamilymedicineohio, Llc 102 W Ash St Continental OH 45831-9162 Ph: (561) 305-9856 |
| NPI Number | 1619685500 |
|---|---|
| Provider Enumeration Date | 11/09/2022 |
| Last Update Date | 01/31/2023 |
| Medicare PECOS PAC ID | 6103290127 |
|---|---|
| Medicare Enrollment ID | O20230314002618 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619685500 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Stacie Hicks |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649206889 PECOS PAC ID: 7315932969 Enrollment ID: I20211217002137 |
Continental Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 102 West Ash St, Continental, OH 45831 Phone: 419-596-3133 |