Healthcare Provider Details

I. General information

NPI: 1487713632
Provider Name (Legal Business Name): EDWARD N. BARR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 E LINCOLNWAY
MINERVA OH
44657-1216
US

IV. Provider business mailing address

1028 E LINCOLNWAY
MINERVA OH
44657-1216
US

V. Phone/Fax

Practice location:
  • Phone: 330-868-6044
  • Fax: 330-868-6847
Mailing address:
  • Phone: 330-868-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN B BARR
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-868-6044