Full Name | |
---|---|
Speciality | Family Medicine |
Location | 55 Elva Ct, Vandalia, Ohio |
Authorized Official Name and Position | Kenneth Prunier (PRESIDENT/CEO) |
Authorized Official Contact | 9372088213 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
55 Elva Ct Vandalia OH 45377-1875 Ph: (937) 208-7500 | 55 Elva Ct Vandalia OH 45377-1875 Ph: (937) 208-7500 |
NPI Number | 1104879097 |
---|---|
Provider Enumeration Date | 05/19/2006 |
Last Update Date | 08/27/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104879097 | NPI | - | NPPES |
0109368 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Hocks Wellness Consulting Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 535 S Dixie Dr, Vandalia, OH 45377 Phone: 937-889-2121 Fax: 937-898-9340 | |
North Dayton Addiction & Recovery, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 117 S Dixie Drive, Suite 4, Vandalia, OH 45377 Phone: 937-416-5442 | |