Healthcare Provider Details

I. General information

NPI: 1215471016
Provider Name (Legal Business Name): BEST OBSERVATION PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SIXTH ST SW
CANTON OH
44710-1702
US

IV. Provider business mailing address

2600 SIXTH ST SW
CANTON OH
44710-1702
US

V. Phone/Fax

Practice location:
  • Phone: 330-456-2695
  • Fax: 330-588-8605
Mailing address:
  • Phone: 330-456-2695
  • Fax: 330-588-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM G CLARK
Title or Position: PHYSICIAN
Credential: MD
Phone: 330-456-2695