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7211 N Main St Suite 1 Dayton OH 45415-2566 | |
| (937) 274-2117 | |
| (937) 274-9809 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 7211 N Main St, Dayton, Ohio |
| Authorized Official Name and Position | Mark A Couch (PRESIDENT) |
| Authorized Official Contact | 9378783600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
25 Merchant St Ste 220 - Attn Credentialing Cincinnati OH 45246-3740 Ph: (513) 533-1199 | 7211 N Main St Suite 1 Dayton OH 45415-2566 Ph: (937) 274-2117 |
| NPI Number | 1043277346 |
|---|---|
| Provider Enumeration Date | 04/28/2006 |
| Last Update Date | 07/15/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043277346 | NPI | - | NPPES |
| 2186174 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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