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DIANA BREWSTER D.O. LLC NPI 1881097087


NPI Information

NPI: 1881097087
Provider Name: DIANA BREWSTER, D.O., LLC

Doing Business As: BREWSTER FAMILY WELLNESS CENTER

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 36D1045139

Address:
4124 FULTON DR NW
STE 101
CANTON, OH
ZIP 44718
Phone: (330) 433-9260
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DIANA BREWSTER, D.O., LLC is a family medicine in Canton, OH. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DIANA BREWSTER, D.O., LLC NPI is 1881097087. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Brewster Family Wellness Center.

The provider's business location address is:

4124 FULTON DR NW
STE 101
CANTON, OH
ZIP 44718-852
Phone: (330) 433-9260
Fax: (330) 433-9263

The provider's authorized official is Diana Brewster .
The authorized official title is Owner and has the following contact phone number (330) 433-9260.

The CLIA number assigned to this NPI record is 36D1045139 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/1/2014 and was last updated on 10/1/2014.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine34007790OHIOYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
12399855MEDICAIDOHIO

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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