| |
701 E Home Rd Springfield OH 45503-2714 | |
(937) 324-1111 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 701 E Home Rd, Springfield, Ohio |
Authorized Official Name and Position | Shonda Ellen Wallace (CFO) |
Authorized Official Contact | 9373241111 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
651 S Limestone St Springfield OH 45505-1965 Ph: () - | 701 E Home Rd Springfield OH 45503-2714 Ph: (937) 324-1111 |
NPI Number | 1770282642 |
---|---|
Provider Enumeration Date | 02/28/2023 |
Last Update Date | 11/20/2024 |
Medicare PECOS PAC ID | 4789653890 |
---|---|
Medicare Enrollment ID | O20240720000183 |
Identifier | Type | State | Issuer |
---|---|---|---|
1770282642 | NPI | - | NPPES |
0063400 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Jyothi Puram, M.d., Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1176 E Home Rd, Springfield, OH 45503 Phone: 937-342-9861 Fax: 380-203-1298 | |
Ajaz Umerani, M.d. Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2121 E High St, Springfield, OH 45505 Phone: 937-325-3830 Fax: 937-325-3780 | |
Usacs Integrated Acute Care Services Of Ohio, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 100 Medical Center Dr, Springfield, OH 45504 Phone: 330-994-4409 | |
Rodney Family Practice Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2057 S Limestone St, Springfield, OH 45505 Phone: 937-323-4003 Fax: 937-323-4023 |