| John Ditraglia Inc | |
|
717 5th St Portsmouth OH 45662-4007 | |
| (740) 354-6605 | |
| (740) 354-1565 |
| Full Name | John Ditraglia Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 717 5th St, Portsmouth, Ohio |
| Authorized Official Name and Position | John Francis Ditraglia (OWNER) |
| Authorized Official Contact | 7403546605 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John Ditraglia Inc 717 5th St Portsmouth OH 45662-4007 Ph: (740) 354-6605 | John Ditraglia Inc 717 5th St Portsmouth OH 45662-4007 Ph: (740) 354-6605 |
| NPI Number | 1093920506 |
|---|---|
| Provider Enumeration Date | 05/10/2007 |
| Last Update Date | 03/18/2019 |
| Medicare PECOS PAC ID | 7315288016 |
|---|---|
| Medicare Enrollment ID | O20190405002223 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093920506 | NPI | - | NPPES |
| 64781438 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 35047660 (Ohio) | Primary |
| 261QR1300X | Clinic/center - Rural Health | 35047660 (Ohio) | Secondary |
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