| Fauster Cameron Inc., Dba Defiance Clinic | |
|
102 West Ash St Continental OH 45831 | |
| (419) 596-3133 | |
| Not Available |
| Full Name | Fauster Cameron Inc., Dba Defiance Clinic |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 102 West Ash St, Continental, Ohio |
| Authorized Official Name and Position | Chad L Peter (CEO) |
| Authorized Official Contact | 4197841414 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fauster Cameron Inc., Dba Defiance Clinic 102 West Ash St Continental OH 45831 Ph: (419) 596-3133 | Fauster Cameron Inc., Dba Defiance Clinic 102 West Ash St Continental OH 45831 Ph: (419) 596-3133 |
| NPI Number | 1659573046 |
|---|---|
| Provider Enumeration Date | 06/05/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659573046 | NPI | - | NPPES |
| 0121746 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Hicksfamilymedicineohio, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 102 W Ash St, Continental, OH 45831 Phone: 561-305-9856 |