| Samuel T. Detwiler, D.o. Llc | |
|
8231 Main St Kinsman OH 44428-9514 | |
| (330) 876-1111 | |
| (330) 876-1005 |
| Full Name | Samuel T. Detwiler, D.o. Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 8231 Main St, Kinsman, Ohio |
| Authorized Official Name and Position | Samuel T Detwiler (PRESIDENT) |
| Authorized Official Contact | 3308761111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Samuel T. Detwiler, D.o. Llc 8231 Main St Po Box 99 Kinsman OH 44428-9514 Ph: (330) 876-1111 | Samuel T. Detwiler, D.o. Llc 8231 Main St Kinsman OH 44428-9514 Ph: (330) 876-1111 |
| NPI Number | 1578648895 |
|---|---|
| Provider Enumeration Date | 10/26/2006 |
| Last Update Date | 09/09/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578648895 | NPI | - | NPPES |
| 2760016 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 34-007985 (Ohio) | Primary |
| 363LF0000X | Nurse Practitioner - Family | NP-04053 (Ohio) | Secondary |
Burghill Vernon Fire Dept Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6915 State Route 88, Kinsman, OH 44428 Phone: 330-772-3013 Fax: 330-772-2874 | |
Upmc Community Medicine Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8511 Main St, Kinsman, OH 44428 Phone: 330-876-1662 |