| Nicholas Landry D.o. Inc. | |
|
1354 Jackson Pike Gallipolis OH 45631-2601 | |
| (740) 441-9800 | |
| (740) 441-9400 |
| Full Name | Nicholas Landry D.o. Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 1354 Jackson Pike, Gallipolis, Ohio |
| Authorized Official Name and Position | Nicholas V Landry (CEO) |
| Authorized Official Contact | 7404419800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicholas Landry D.o. Inc. 1325 Northup Rd Gallipolis OH 45631-8830 Ph: (740) 441-9800 | Nicholas Landry D.o. Inc. 1354 Jackson Pike Gallipolis OH 45631-2601 Ph: (740) 441-9800 |
| NPI Number | 1508967910 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 05/21/2020 |
| Medicare PECOS PAC ID | 1658283247 |
|---|---|
| Medicare Enrollment ID | O20031103000302 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508967910 | NPI | - | NPPES |
| 5630097000 | Medicaid | WV | |
| $$$$$$$$$ | Other | WV | SOCIAL SECURITY NUMBER |
| 2144067 | Medicaid | OH | |
| 000000303053 | Other | OH | ANTHEM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Nicholas Vito Landry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992781538 PECOS PAC ID: 0941112536 Enrollment ID: I20031104000203 |
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