# INDEPENDENT PROVIDER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Independent Provider
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821217308
- **Authorized official:** MRS. WENDY SUE CAPPER (INDEPENDENT PROVIDER)
- **Authorized official phone:** (937) 324-4438

## Contact information

- **Practice address:** 2273 NEWLOVE RD, S CHARLESTON, OH 45368-9732
- **Practice address phone:** (937) 324-4438
- **Mailing address:** PO BOX 427, S CHARLESTON, OH 45368-0427
- **Mailing address phone:** (937) 324-4438

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | SK307751 | OH | Yes |
| 305R00000X | Preferred Provider Organization | SK307751 | OH | — |

## Other

- **Enumeration date:** 04/24/2007
- **Last updated:** 09/11/2025