Kenton Family Practice Llc | |
75 Washington Blvd Kenton OH 43326-4001 | |
(419) 675-1962 | |
(419) 673-8058 |
Full Name | Kenton Family Practice Llc |
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Speciality | Family Medicine |
Location | 75 Washington Blvd, Kenton, Ohio |
Authorized Official Name and Position | Paul D Wesson (PHYSICIAN) |
Authorized Official Contact | 4196751962 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Kenton Family Practice Llc Po Box 418 Kenton OH 43326-0418 Ph: (419) 675-1962 | Kenton Family Practice Llc 75 Washington Blvd Kenton OH 43326-4001 Ph: (419) 675-1962 |
NPI Number | 1083779110 |
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Provider Enumeration Date | 12/27/2006 |
Last Update Date | 09/29/2010 |
Medicare PECOS PAC ID | 2264322536 |
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Medicare Enrollment ID | O20040318001629 |
Identifier | Type | State | Issuer |
---|---|---|---|
1083779110 | NPI | - | NPPES |
0174289 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Paul David Wesson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1659362176 PECOS PAC ID: 2961392238 Enrollment ID: I20040319000349 |
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