| Sandusky Family Practice Inc | |
|
3103 Campbell St Sandusky OH 44870-7230 | |
| (419) 625-4461 | |
| (419) 625-5199 |
| Full Name | Sandusky Family Practice Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 3103 Campbell St, Sandusky, Ohio |
| Authorized Official Name and Position | James Jefferson Wysor (PHYSICIAN) |
| Authorized Official Contact | 4196254461 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sandusky Family Practice Inc 3103 Campbell St Sandusky OH 44870-7230 Ph: (419) 625-4461 | Sandusky Family Practice Inc 3103 Campbell St Sandusky OH 44870-7230 Ph: (419) 625-4461 |
| NPI Number | 1396816708 |
|---|---|
| Provider Enumeration Date | 11/10/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1951426147 |
|---|---|
| Medicare Enrollment ID | O20100910000930 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396816708 | NPI | - | NPPES |
| 000000131843 | Other | OH | ANTHEM |
| 04375 | Other | OH | PARAMOUNT |
| 20636020100 | Other | OH | BWC |
| 0538681 | Medicaid | OH | |
| 206360201001 | Other | OH | MED MUTUAL OF OHIO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 35-047619 (Ohio) | Primary |
| Provider Name | Richard R Keller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356314421 PECOS PAC ID: 1456440270 Enrollment ID: I20100910001053 |
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