| Kenton Family Practice Llc | |
|
75 Washington Blvd Kenton OH 43326-4001 | |
| (419) 675-1962 | |
| (419) 673-8058 |
| Full Name | Kenton Family Practice Llc |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 12/27/2006 |
| Last Update Date | 09/29/2010 |
| Medicare PECOS PAC ID | 2264322536 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659362176 PECOS PAC ID: 2961392238 Enrollment ID: I20040319000349 |
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