RICHARD D WATKINS CANTON COMMUNITY CLINIC INC NPI 1619319043

NPI Information

NPI: 1619319043
Provider Name: RICHARD D WATKINS CANTON COMMUNITY CLINIC, INC

Doing Business As: MAHONING ROAD FAMILY HEALTH CENTER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
3015 MAHONING RD NE
CANTON, OH
ZIP 44705
Phone: (330) 454-2000
Get Directions

RICHARD D WATKINS CANTON COMMUNITY CLINIC, INC is a federally qualified health center (fqhc) clinic center in Canton, OH. RICHARD D WATKINS CANTON COMMUNITY CLINIC, INC NPI is 1619319043. The provider is registered as an organization entity type.
The provider Is Doing Business As Mahoning Road Family Health Center.

The provider's business location address is:

3015 MAHONING RD NE
CANTON, OH
ZIP 44705-335
Phone: (330) 454-2000
Fax: (330) 454-6184

The provider's authorized official is David Cola .
The authorized official title is Ceo and has the following contact phone number (330) 454-2000.

The enumeration date for this NPI number is 7/26/2013 and was last updated on 7/14/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	361035	MEDICARE PIN	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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