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General NPI Number Information
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NPI Number | 1851031272
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Entity Type | Organization
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Legal Business Name | DR MCH PA-C LLC
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 681 WYNDCLIFT CIR
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City | YOUNGSTOWN
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State | OH
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Zip | 44515-4368
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Country | US
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Telephone | 330-774-4405
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Fax |
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Provider Business Mailing Address
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Address Line | 681 WYNDCLIFT CIR
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City | YOUNGSTOWN
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State | OH
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Zip | 44515-4368
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Country | US
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Telephone | 330-774-4405
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MIQUITA C HOSEY
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Credential | PA-C
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Telephone | 330-774-4405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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