| Integrated Medicine Of Ohio Llc | |
|
2780 S Arlington Rd Ste 202 Coventry Township OH 44312-4707 | |
| (330) 644-5488 | |
| (330) 644-5488 |
| Full Name | Integrated Medicine Of Ohio Llc |
|---|---|
| Speciality | General Practice |
| Location | 2780 S Arlington Rd Ste 202, Coventry Township, Ohio |
| Authorized Official Name and Position | Caroline Boardman (MANAGING MEMBER) |
| Authorized Official Contact | 3306445488 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Medicine Of Ohio Llc 2780 S Arlington Rd Ste 202 Coventry Township OH 44312-4707 Ph: (330) 644-5488 | Integrated Medicine Of Ohio Llc 2780 S Arlington Rd Ste 202 Coventry Township OH 44312-4707 Ph: (330) 644-5488 |
| NPI Number | 1437796042 |
|---|---|
| Provider Enumeration Date | 12/02/2019 |
| Last Update Date | 01/28/2020 |
| Medicare PECOS PAC ID | 5799113643 |
|---|---|
| Medicare Enrollment ID | O20200309000421 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437796042 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Tyecia M Stevens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245613918 PECOS PAC ID: 3870893175 Enrollment ID: I20151118000513 |
| Provider Name | Susan Gutlove |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447627708 PECOS PAC ID: 1456656990 Enrollment ID: I20160222002367 |
| Provider Name | Emily Anne Devol |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1023461316 PECOS PAC ID: 6406111418 Enrollment ID: I20180522002378 |