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40 Munroe Falls Ave Munroe Falls OH 44262-1538 | |
(234) 571-9131 | |
(234) 571-2677 |
Full Name | |
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Speciality | Clinic/Center |
Location | 40 Munroe Falls Ave, Munroe Falls, Ohio |
Authorized Official Name and Position | Kendrick B Bashor (REPRESENTATIVE) |
Authorized Official Contact | 3303521616 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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40 Munroe Falls Ave Munroe Falls OH 44262-1538 Ph: (234) 571-9131 | 40 Munroe Falls Ave Munroe Falls OH 44262-1538 Ph: (234) 571-9131 |
NPI Number | 1316455793 |
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Provider Enumeration Date | 01/18/2018 |
Last Update Date | 06/16/2018 |
Medicare PECOS PAC ID | 8820350952 |
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Medicare Enrollment ID | O20180329000544 |
Identifier | Type | State | Issuer |
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1316455793 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Kendrick Bashor |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1457355083 PECOS PAC ID: 4284724287 Enrollment ID: I20071213000865 |