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10724 State Route 212 Ne Bolivar OH 44612-8740 | |
(330) 874-7165 | |
(330) 874-7166 |
Full Name | |
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Speciality | Clinic/Center |
Location | 10724 State Route 212 Ne, Bolivar, Ohio |
Authorized Official Name and Position | Adam M Luntz (CFO) |
Authorized Official Contact | 3303633889 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 80690 Canton OH 44708-0690 Ph: (330) 363-7444 | 10724 State Route 212 Ne Bolivar OH 44612-8740 Ph: (330) 874-7165 |
NPI Number | 1376172866 |
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Provider Enumeration Date | 04/06/2020 |
Last Update Date | 02/03/2025 |
Medicare PECOS PAC ID | 7911890546 |
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Medicare Enrollment ID | O20200601001321 |
Identifier | Type | State | Issuer |
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1376172866 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |