| Independence Healthcare Llc | |
|
4595 Walnut Rd Ste L Buckeye Lake OH 43008-7909 | |
| (740) 822-0080 | |
| (740) 822-0081 |
| Full Name | Independence Healthcare Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4595 Walnut Rd Ste L, Buckeye Lake, Ohio |
| Authorized Official Name and Position | Khadie Muriel Thomas (NURSE PRACTITIONER) |
| Authorized Official Contact | 6148936800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Independence Healthcare Llc 4595 Walnut Rd Ste L Buckeye Lake OH 43008-7909 Ph: (740) 822-0080 | Independence Healthcare Llc 4595 Walnut Rd Ste L Buckeye Lake OH 43008-7909 Ph: (740) 822-0080 |
| NPI Number | 1699556746 |
|---|---|
| Provider Enumeration Date | 10/12/2023 |
| Last Update Date | 07/05/2024 |
| Medicare PECOS PAC ID | 7315381498 |
|---|---|
| Medicare Enrollment ID | O20240216000888 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699556746 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Khadie Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831679612 PECOS PAC ID: 3072849629 Enrollment ID: I20190719002359 |
The Training Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5179 Walnut Rd, Buckeye Lake, OH 43008 Phone: 740-438-8863 Fax: 740-205-0097 |