Basic Information
| Provider Information | |||||||||
| NPI: | 1174792014 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERRY COUNTY FAMILY PRACTICE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 596 | ||||||||
| Address2: | |||||||||
| City: | NEW LEXINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437640596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403425158 | ||||||||
| FaxNumber: | 7403427393 | ||||||||
| Practice Location | |||||||||
| Address1: | 1625 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | NEW LEXINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437649749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403425158 | ||||||||
| FaxNumber: | 7403427393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2008 | ||||||||
| LastUpdateDate: | 05/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | YARGER | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | ACCOUNTS RECEIVABLE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7403423435 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 35-042516 | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 363829 | 01 | OH | RURAL HEALTH MEDICARE | OTHER | 0940996 | 01 | OH | RURAL HEALTH MEDICAID | OTHER |