Provider Demographics
NPI:1174792014
Name:PERRY COUNTY FAMILY PRACTICE, INC.
Entity type:Organization
Organization Name:PERRY COUNTY FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:YARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-342-3435
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-0596
Mailing Address - Country:US
Mailing Address - Phone:740-342-5158
Mailing Address - Fax:740-342-7393
Practice Address - Street 1:1625 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-9749
Practice Address - Country:US
Practice Address - Phone:740-342-5158
Practice Address - Fax:740-342-7393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-042516261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH363829OtherRURAL HEALTH MEDICARE
OH0940996OtherRURAL HEALTH MEDICAID
363829Medicare Oscar/Certification