Full Name | |
---|---|
Speciality | Family Medicine |
Location | 2 Success Blvd., Perry, Ohio |
Authorized Official Name and Position | Robert Tracz (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 4403541642 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 714328 Columbus OH 43271-4328 Ph: (440) 375-8590 | 2 Success Blvd. Perry OH 44081 Ph: (440) 375-8590 |
NPI Number | 1174762512 |
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Provider Enumeration Date | 02/09/2009 |
Last Update Date | 02/09/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174762512 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |