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103 W Main St Salineville OH 43945-1048 | |
(330) 679-2640 | |
(330) 679-2641 |
Full Name | |
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Speciality | Clinic/Center |
Location | 103 W Main St, Salineville, Ohio |
Authorized Official Name and Position | Jenna Wonner (COO) |
Authorized Official Contact | 3304247221 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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7880 Lincole Pl Lisbon OH 44432-8322 Ph: (330) 424-7221 | 103 W Main St Salineville OH 43945-1048 Ph: (330) 679-2640 |
NPI Number | 1508114893 |
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Provider Enumeration Date | 08/17/2012 |
Last Update Date | 09/11/2020 |
Medicare PECOS PAC ID | 8123928645 |
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Medicare Enrollment ID | O20121029000060 |
Identifier | Type | State | Issuer |
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1508114893 | NPI | - | NPPES |
0077813 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |