Healthcare Provider Details

I. General information

NPI: 1306158944
Provider Name (Legal Business Name): CHARLES M AMMON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 WEST 5TH STREET
EAST LIVERPOOL OH
43920-3734
US

IV. Provider business mailing address

380 SUMMIT AVENUE MSO PHYSICIAN BILLING
STEUBENVILLE OH
43952-2667
US

V. Phone/Fax

Practice location:
  • Phone: 330-382-0165
  • Fax: 330-382-0275
Mailing address:
  • Phone: 740-283-7597
  • Fax: 740-283-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.11984
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License NumberRN270498
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: