| Primetown Ohio Llc | |
|
905 N 21st St Ste A Newark OH 43055-7251 | |
| (740) 281-3663 | |
| (740) 281-3818 |
| Full Name | Primetown Ohio Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 905 N 21st St Ste A, Newark, Ohio |
| Authorized Official Name and Position | Stephanie Rice (OWNER) |
| Authorized Official Contact | 7407041225 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primetown Ohio Llc 905 N 21st St Ste A Newark OH 43055-7251 Ph: (740) 281-3663 | Primetown Ohio Llc 905 N 21st St Ste A Newark OH 43055-7251 Ph: (740) 281-3663 |
| NPI Number | 1124733167 |
|---|---|
| Provider Enumeration Date | 01/13/2023 |
| Last Update Date | 10/26/2023 |
| Medicare PECOS PAC ID | 4587038005 |
|---|---|
| Medicare Enrollment ID | O20230324001197 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124733167 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Melanie Faith Sinclair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861085243 PECOS PAC ID: 0446650881 Enrollment ID: I20210607002376 |
| Provider Name | Selena Linda Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124715503 PECOS PAC ID: 6709232481 Enrollment ID: I20231101001892 |
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