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3864 Center Rd Ste B1 Brunswick OH 44212 | |
| (330) 220-8950 | |
| (330) 220-9167 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 3864 Center Rd, Brunswick, Ohio |
| Authorized Official Name and Position | Terrance K. Dillon (ASSISTANT SECRETARY) |
| Authorized Official Contact | 5025967220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3864 Center Rd Ste B1 Brunswick OH 44212-6601 Ph: (330) 220-8950 | 3864 Center Rd Ste B1 Brunswick OH 44212 Ph: (330) 220-8950 |
| NPI Number | 1811303654 |
|---|---|
| Provider Enumeration Date | 07/01/2014 |
| Last Update Date | 04/30/2019 |
| Medicare PECOS PAC ID | 0042128894 |
|---|---|
| Medicare Enrollment ID | O20141003002312 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811303654 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QR0400X | Clinic/center - Rehabilitation | (* (Not Available)) | Primary |
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