Healthcare Provider Details

I. General information

NPI: 1497724140
Provider Name (Legal Business Name): CHARLES P HOUSE SR DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W MAPLE ST
CLYDE OH
43410-1414
US

IV. Provider business mailing address

PO BOX 179
BELLEVUE OH
44811-0179
US

V. Phone/Fax

Practice location:
  • Phone: 419-547-0584
  • Fax: 419-547-8918
Mailing address:
  • Phone: 440-274-5035
  • Fax: 440-716-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES P HOUSE SR.
Title or Position: PRESIDENT
Credential: DO
Phone: 419-547-0584