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NPI Code Detail

MEDICARE: ZACHARY J BOUTWELL

MEDICARE: ZACHARY J BOUTWELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorOH

General Provider Information

NPI Number : 1255112165
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZACHARY J BOUTWELL
Provider Business Mailing Address
First Line : 10100 ELIDA RD
Second Line :
City : DELPHOS
State : OH
Zip : 45833-9058
Country : US
Telephone Number : 419-895-8010
Fax Number :
Provider Business Practice Location Address
First Line : 11590 CENTURY BLVD STE 116
Second Line :
City : CINCINNATI
State : OH
Zip : 45246-3317
Country : US
Telephone Number : 419-695-8010
Fax Number : 419-932-6232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2023
Last Update Date : 02/06/2026

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