MEDICARE: TOTAL LIVING CENTER FREE 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	O13679	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	:	1982748414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL LIVING CENTER FREE CLINIC

Provider Business Mailing Address
First Line	:	2221 9TH ST SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44706
Country	:	US
Telephone Number	:	330-478-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 9TH ST SW FREE CLINIC
Second Line	:	2221 9TH ST SW
City	:	CANTON
State	:	OH
Zip	:	44706
Country	:	US
Telephone Number	:	330-455-3663
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	EDWARD ARTHUR HILL
Credential	:	MD
Telephone Number	:	330-478-0400

Provider Enumeration Date	:	02/17/2007
Last Update Date	:	07/30/2008

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