| Shiloh Family Medicine Llc | |
|
5900 N Main St Ste 3 Dayton OH 45415-3198 | |
| (937) 277-9371 | |
| Not Available |
| Full Name | Shiloh Family Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5900 N Main St Ste 3, Dayton, Ohio |
| Authorized Official Name and Position | Edward Clack (PHYSICIAN) |
| Authorized Official Contact | 9372779371 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shiloh Family Medicine Llc 5900 N Main St Ste 3 Dayton OH 45415-3198 Ph: (937) 277-9371 | Shiloh Family Medicine Llc 5900 N Main St Ste 3 Dayton OH 45415-3198 Ph: (937) 277-9371 |
| NPI Number | 1255526471 |
|---|---|
| Provider Enumeration Date | 09/11/2007 |
| Last Update Date | 01/03/2023 |
| Medicare PECOS PAC ID | 7214051531 |
|---|---|
| Medicare Enrollment ID | O20100824000248 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255526471 | NPI | - | NPPES |
| 000000236927 | Other | ANTHEM | |
| 2353911 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Eric E Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033409628 PECOS PAC ID: 6901076033 Enrollment ID: I20110829000708 |
| Provider Name | Edward P Clack |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659629053 PECOS PAC ID: 7315186277 Enrollment ID: I20141122000327 |
| Provider Name | Zachary James Hale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356992028 PECOS PAC ID: 4284066952 Enrollment ID: I20191118003119 |
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