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621 E 5th St Waverly OH 45690-1505 | |
| (740) 947-8670 | |
| (740) 947-8680 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 621 E 5th St, Waverly, Ohio |
| Authorized Official Name and Position | Robert Tyree (PHYSICIAN) |
| Authorized Official Contact | 7409478670 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
621 E 5th St Waverly OH 45690-1505 Ph: (740) 947-8670 | 621 E 5th St Waverly OH 45690-1505 Ph: (740) 947-8670 |
| NPI Number | 1780881789 |
|---|---|
| Provider Enumeration Date | 07/02/2007 |
| Last Update Date | 01/25/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780881789 | NPI | - | NPPES |
| 0213254 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 35064727 (Ohio) | Primary |
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