MEDICARE: EAST LIVERPOOL FAMILY PRACTICE, LTD.

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	207Q00000X	Family Medicine Physician	3400490	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760502074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST LIVERPOOL FAMILY PRACTICE, LTD.

Provider Business Mailing Address
First Line	:	16494 SAINT CLAIR AVE
Second Line	:	SUITE A
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-9400
Country	:	US
Telephone Number	:	330-386-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	16494 SAINT CLAIR AVE
Second Line	:	SUITE A
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-9400
Country	:	US
Telephone Number	:	330-386-3311
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LESTER H HILL
Credential	:	DO
Telephone Number	:	330-386-3311

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	04/20/2008

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Directions to “EAST LIVERPOOL FAMILY PRACTICE, LTD. ” Practice Location

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