MEDICARE: NEW WASHINGTON MEDICAL PRACTICE

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
1	207Q00000X	Family Medicine Physician	34-00-5150	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912076118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW WASHINGTON MEDICAL PRACTICE

Provider Business Mailing Address
First Line	:	120 W MAIN ST
Second Line	:	P.O. BOX 456
City	:	NEW WASHINGTON
State	:	OH
Zip	:	44854-9431
Country	:	US
Telephone Number	:	419-492-2225
Fax Number	:	419-492-2191

Provider Business Practice Location Address
First Line	:	120 W MAIN ST
Second Line	:
City	:	NEW WASHINGTON
State	:	OH
Zip	:	44854-9431
Country	:	US
Telephone Number	:	419-492-2225
Fax Number	:	419-492-2191

Authorized Official
Title or Position	:	CEO
Name	:	DR. RACHEL L JOHNSON
Credential	:	D.O.
Telephone Number	:	419-492-2225

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	08/22/2020

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Directions to “NEW WASHINGTON MEDICAL PRACTICE ” Practice Location

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