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General NPI Number Information
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NPI Number | 1497724140
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Entity Type | Organization
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Legal Business Name | CHARLES P HOUSE SR DO
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 02/23/2015
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Provider Practice Location Address
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Address Line | 700 W MAPLE ST
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City | CLYDE
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State | OH
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Zip | 43410-1414
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Country | US
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Telephone | 419-547-0584
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Fax | 419-547-8918
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Provider Business Mailing Address
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Address Line | PO BOX 179
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City | BELLEVUE
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State | OH
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Zip | 44811-0179
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Country | US
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Telephone | 440-274-5035
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Fax | 440-716-8608
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES P HOUSE SR.
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Credential | DO
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Telephone | 419-547-0584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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