MEDICARE: CR INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1124311626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CR INC

Provider Business Mailing Address
First Line	:	17 E BROAD ST
Second Line	:
City	:	NEWTON FALLS
State	:	OH
Zip	:	44444-1604
Country	:	US
Telephone Number	:	330-872-3273
Fax Number	:	330-609-5056

Provider Business Practice Location Address
First Line	:	17 E BROAD ST
Second Line	:
City	:	NEWTON FALLS
State	:	OH
Zip	:	44444-1604
Country	:	US
Telephone Number	:	330-872-3273
Fax Number	:	330-609-5056

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHARLES R VERBANIC
Credential	:	D.D.S
Telephone Number	:	330-872-3273

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	12/28/2011

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Directions to “CR INC ” Practice Location

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