| Prospect Family Medicine, Inc. | |
|
102 Water Street Prospect OH 43342 | |
| (740) 494-2624 | |
| (740) 494-9013 |
| Full Name | Prospect Family Medicine, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 102 Water Street, Prospect, Ohio |
| Authorized Official Name and Position | Mark John Piacentini (PRESIDENT) |
| Authorized Official Contact | 7404942624 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prospect Family Medicine, Inc. 102 E Water Street Post Office Box 203 Prospect OH 43342-0203 Ph: (740) 494-2624 | Prospect Family Medicine, Inc. 102 Water Street Prospect OH 43342 Ph: (740) 494-2624 |
| NPI Number | 1487895967 |
|---|---|
| Provider Enumeration Date | 03/13/2009 |
| Last Update Date | 05/17/2013 |
| Medicare PECOS PAC ID | 8527251313 |
|---|---|
| Medicare Enrollment ID | O20101025001403 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487895967 | NPI | - | NPPES |
| 0669174 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 35054820P (Ohio) | Primary |
| Provider Name | Cheryl Ledwick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205805702 PECOS PAC ID: 7911963442 Enrollment ID: I20041207000582 |
| Provider Name | Mark J Piacentini |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568478626 PECOS PAC ID: 7214944289 Enrollment ID: I20060315000821 |