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General NPI Number Information
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NPI Number | 1992996524
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Entity Type | Organization
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Legal Business Name | WAUSEON CLINIC CORP
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 495 S SHOOP AVE
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City | WAUSEON
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State | OH
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Zip | 43567-1719
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Country | US
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Telephone | 419-335-7921
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Fax | 419-337-5988
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Provider Business Mailing Address
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Address Line | PO BOX 418
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City | WAUSEON
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State | OH
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Zip | 43567-0418
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Country | US
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Telephone | 419-335-7921
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Fax | 419-337-5988
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD JOHN GRIESER
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Credential | MD
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Telephone | 419-335-7921
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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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