| Clark Kellogg, | |
|
799 Lexington Ave, Mansfield, OH 44907-1906 | |
| (419) 756-5133 | |
| (419) 774-9707 |
| Full Name | Clark Kellogg |
|---|---|
| Gender | Male |
| Speciality | Anesthesiology Assistant |
| Experience | 3 Years |
| Location | 799 Lexington Ave, Mansfield, Ohio |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457098154 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367H00000X | Anesthesiologist Assistant | 32698321 (Ohio) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Ohiohealth Mansfield Hospital | Mansfield, OH | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Anesthesia Associates Of Mansfield, Inc | 3870486624 | 24 |
| Entity Name | Anesthesia Associates Of Mansfield, Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1407947815 PECOS PAC ID: 3870486624 Enrollment ID: O20040205000222 |
| Mailing Address | Practice Location Address |
|---|---|
| Clark Kellogg, 5910 Bluestone Way, Lewis Center, OH 43035-7550 Ph: (614) 301-2639 | Clark Kellogg, 799 Lexington Ave, Mansfield, OH 44907-1906 Ph: (419) 756-5133 |
Mr. Nathaniel A Walton, AA Anesthesiologist Assistant Medicare: Accepting Medicare Assignments Practice Location: 799 Lexington Ave, Mansfield, OH 44907 Phone: 419-756-5133 Fax: 419-774-9707 | |
Wosen D Assefa, Anesthesiologist Assistant Medicare: Accepting Medicare Assignments Practice Location: 335 Glessner Ave, Mansfield, OH 44903 Phone: 216-816-6982 | |
Vincent James Cancilla, Anesthesiologist Assistant Medicare: Not Enrolled in Medicare Practice Location: 335 Glessner Ave, Mansfield, OH 44903 Phone: 419-520-2882 | |
Mr. Joel Baker, Anesthesiologist Assistant Medicare: Accepting Medicare Assignments Practice Location: 799 Lexington Ave, Mansfield, OH 44907 Phone: 419-756-5133 | |
Abigail C Mcmullen, Anesthesiologist Assistant Medicare: Accepting Medicare Assignments Practice Location: 335 Glessner Ave, Mansfield, OH 44903 Phone: 419-526-8000 |