MEDICARE: TWIG I WELL BABY CLINIC

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	261QH0100X	Health Service Clinic/Center		OH

General Provider Information

NPI Number	:	1407014558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIG I WELL BABY CLINIC

Provider Business Mailing Address
First Line	:	205 W CENTER ST
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-3700
Country	:	US
Telephone Number	:	740-382-0694
Fax Number	:	740-382-0694

Provider Business Practice Location Address
First Line	:	205 W CENTER ST
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-3700
Country	:	US
Telephone Number	:	740-382-0694
Fax Number	:	740-382-0694

Authorized Official
Title or Position	:	CLINIC COORDINATOR
Name	:	MRS. CINDY ANN STRZALKA
Credential	:
Telephone Number	:	740-382-0694

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	07/21/2022

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