| Western Avenue Family Practice Llc | |
|
1101 Western Ave Hamilton OH 45013-2313 | |
| (513) 887-2000 | |
| (513) 887-2300 |
| Full Name | Western Avenue Family Practice Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1101 Western Ave, Hamilton, Ohio |
| Authorized Official Name and Position | Kimberly C Haugabook (OWNER) |
| Authorized Official Contact | 5138872000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Western Avenue Family Practice Llc 1101 Western Ave Hamilton OH 45013-2313 Ph: () - | Western Avenue Family Practice Llc 1101 Western Ave Hamilton OH 45013-2313 Ph: (513) 887-2000 |
| NPI Number | 1447713052 |
|---|---|
| Provider Enumeration Date | 04/10/2019 |
| Last Update Date | 02/22/2023 |
| Medicare PECOS PAC ID | 0648603027 |
|---|---|
| Medicare Enrollment ID | O20191126002168 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447713052 | NPI | - | NPPES |
| H277047 | Other | OH | MEDICARE PTAN |
| DZ5886 | Other | OH | RRMEDICARE PTAN |
| 0373306 | Medicaid | OH |
| Provider Name | Kimberly Carnella Haugabook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437474897 PECOS PAC ID: 1456532357 Enrollment ID: I20150505000360 |
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