| Freedom Center | |
|
106 E Gambier St Mount Vernon OH 43050-3510 | |
| (740) 397-2660 | |
| (740) 392-3613 |
| Full Name | Freedom Center |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 106 E Gambier St, Mount Vernon, Ohio |
| Authorized Official Name and Position | Jeffrey Williams (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7403972660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Freedom Center 106 E Gambier St Mount Vernon OH 43050-3510 Ph: (740) 397-2660 | Freedom Center 106 E Gambier St Mount Vernon OH 43050-3510 Ph: (740) 397-2660 |
| NPI Number | 1275509143 |
|---|---|
| Provider Enumeration Date | 02/28/2006 |
| Last Update Date | 09/28/2016 |
| Medicare PECOS PAC ID | 7911008511 |
|---|---|
| Medicare Enrollment ID | O20160719002145 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275509143 | NPI | - | NPPES |
| 35842 | Other | OH | MBC (MERIT/BIODYNE) |
| OH750732-00 | Other | OH | NFR ID |
| 1311 | Medicaid | OH | |
| 729264 | Other | OH | BWC |
| LICKBO131199 | Other | OH | PSEUDO UCI |
| 45660 | Other | OH | ODADAS AGENCY NUMBER |
| 62-15262 | Other | OH | PHP/UBS NUMBER |
| 3908853 | Other | OH | FDA ID# |
| 62-15262 | Other | OH | UHC OR UBH NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 1311 (Ohio) | Secondary |
| 251S00000X | Community/behavioral Health | 01-7560 (Ohio) | Primary |
| Provider Name | Rebecca Armstr Stilson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1174522627 PECOS PAC ID: 9537192802 Enrollment ID: I20050916000270 |
| Provider Name | Chandravadan P Patel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598883068 PECOS PAC ID: 1153337274 Enrollment ID: I20060228000128 |
| Provider Name | Jeffrey P Koenig |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750636254 PECOS PAC ID: 8022269893 Enrollment ID: I20121105000352 |
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