| Morenci Medical Assoc, Pc | |
|
137 S Fulton St Wauseon OH 43567-1351 | |
| (419) 335-2811 | |
| (419) 335-3388 |
| Full Name | Morenci Medical Assoc, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 137 S Fulton St, Wauseon, Ohio |
| Authorized Official Name and Position | Shivaprasas K Shetty (PRESIDENT) |
| Authorized Official Contact | 4193352811 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Morenci Medical Assoc, Pc 137 S Fulton St Wauseon OH 43567-1351 Ph: (419) 335-2811 | Morenci Medical Assoc, Pc 137 S Fulton St Wauseon OH 43567-1351 Ph: (419) 335-2811 |
| NPI Number | 1962690735 |
|---|---|
| Provider Enumeration Date | 10/05/2007 |
| Last Update Date | 10/05/2007 |
| Medicare PECOS PAC ID | 3870495849 |
|---|---|
| Medicare Enrollment ID | O20040121001122 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962690735 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 35-06-8087S (Ohio) | Primary |
| Provider Name | Shivaprasad K Shetty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235133190 PECOS PAC ID: 5991607863 Enrollment ID: I20040123000793 |
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