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1440 Rockside Rd Ste 202 Parma OH 44134-2749 | |
| (216) 749-8276 | |
| (216) 749-8240 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 1440 Rockside Rd Ste 202, Parma, Ohio |
| Authorized Official Name and Position | Charles R Koepke (PRESIDENT) |
| Authorized Official Contact | 2167498276 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1440 Rockside Rd Ste 202 Parma OH 44134-2749 Ph: (216) 749-8276 | 1440 Rockside Rd Ste 202 Parma OH 44134-2749 Ph: (216) 749-8276 |
| NPI Number | 1285609214 |
|---|---|
| Provider Enumeration Date | 02/22/2006 |
| Last Update Date | 05/10/2018 |
| Medicare PECOS PAC ID | 1355323668 |
|---|---|
| Medicare Enrollment ID | O20040602000099 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285609214 | NPI | - | NPPES |
| 2005145 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | NP09205 (Ohio) | Secondary |
| Provider Name | Bobby W Paul |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902852148 PECOS PAC ID: 0042216228 Enrollment ID: I20061011000349 |
| Provider Name | Charles R Koepke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518951193 PECOS PAC ID: 8426056920 Enrollment ID: I20100216000333 |
| Provider Name | Morgan Koepke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124280474 PECOS PAC ID: 7810167475 Enrollment ID: I20110909002433 |
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