Richard J Mendieta, MD | |
100 Jackson Pike, Gallipolis, OH 45631-1560 | |
(740) 446-5371 | |
(740) 446-5711 |
Full Name | Richard J Mendieta |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 100 Jackson Pike, Gallipolis, Ohio |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1821045204 | NPI | - | NPPES |
310917085028 | Other | OH | CARESOURCE MEDICAID |
0111033000 | Medicaid | WV | |
000000007410 | Other | ANTHEM BCBS | |
000000181967 | Other | OH | UNISON MEDICAID |
2037718 | Other | OH | MOLINA MEDICAID |
370008914 | Other | RR MEDICARE | |
001714096 | Other | MOUNTAIN STATE BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 19317 (West Virginia) | Secondary |
208000000X | Pediatrics | 35.072682 (Ohio) | Secondary |
208000000X | Pediatrics | 35-07-2682 (Ohio) | Primary |
Entity Name | Holzer Clinic Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1508817248 PECOS PAC ID: 5890606008 Enrollment ID: O20040517000510 |
Mailing Address | Practice Location Address |
---|---|
Richard J Mendieta, MD 90 Jackson Pike, Gallipolis, OH 45631-1560 Ph: (740) 441-1949 | Richard J Mendieta, MD 100 Jackson Pike, Gallipolis, OH 45631-1560 Ph: (740) 446-5371 |
Jon M. Sullivan, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 100 Jackson Pike, Gallipolis, OH 45631 Phone: 740-446-5371 Fax: 740-446-5711 | |
Jonathan Mathis, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 100 Jackson Pike, Gallipolis, OH 45631 Phone: 855-446-5937 Fax: 740-446-5711 | |
Mr. Jacob Lawrence Pessia, MS IV Pediatrics Medicare: Medicare Enrolled Practice Location: 100 Jackson Pike, Gallipolis, OH 45631 Phone: 740-441-1949 Fax: 740-446-5982 | |
Shana Allie Vore, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 100 Jackson Pike, Gallipolis, OH 45631 Phone: 855-446-5937 Fax: 740-446-5711 | |
Pradeep K. Kandula, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 100 Jackson Pike, Gallipolis, OH 45631 Phone: 740-446-5371 Fax: 740-446-5711 | |
Danielle T. Cappelletti, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 100 Jackson Pike, Gallipolis, OH 45631 Phone: 740-446-5371 Fax: 740-446-5711 | |
Il H. Kim, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 100 Jackson Pike, Gallipolis, OH 45631 Phone: 740-446-5371 Fax: 740-446-5711 |