Healthcare Provider Details

I. General information

NPI: 1164612933
Provider Name (Legal Business Name): CLEAR SPRINGS MEDICAL CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4774 KIDRON RD.
KIDRON OH
44636
US

IV. Provider business mailing address

PO BOX 268 4774 KIDRON RD.
KIDRON OH
44636-0268
US

V. Phone/Fax

Practice location:
  • Phone: 330-857-5787
  • Fax: 330-857-8812
Mailing address:
  • Phone: 330-857-5787
  • Fax: 330-857-8812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number35080282
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number01531
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number34005514
License Number StateOH

VIII. Authorized Official

Name: DR. DANIEL J CAIN
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 330-857-5787