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112 E Lima St Forest OH 45843-1116 | |
(419) 273-5104 | |
(419) 273-5106 |
Full Name | |
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Speciality | Clinic/Center |
Location | 112 E Lima St, Forest, Ohio |
Authorized Official Name and Position | Ty R Shaull (PRESIDENT & CEO) |
Authorized Official Contact | 4192944991 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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885 N Sandusky Ave Upper Sandusky OH 43351-1098 Ph: (419) 294-4991 | 112 E Lima St Forest OH 45843-1116 Ph: (419) 273-5104 |
NPI Number | 1861908071 |
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Provider Enumeration Date | 12/26/2017 |
Last Update Date | 09/23/2022 |
Medicare PECOS PAC ID | 1557340189 |
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Medicare Enrollment ID | O20230915001914 |
Identifier | Type | State | Issuer |
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1861908071 | NPI | - | NPPES |
0394927 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |