Organization
CARNATION CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RASARIO BAUTISTA (ADMINISTRATOR MGR)
(330) 821-0201
Entity
Organization
Contact information
Practice address
1401 S ARCH AVE, ALLIANCE, OH 44601-4202
(330) 821-0201
(330) 821-1924
Mailing address
1401 S ARCH AVE, ALLIANCE, OH 44601-4202
(330) 821-0201
(330) 821-1924
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0103640
—
OH
01
—
127480600
FEDERAL EMPLOYEE BWC
OH
01
—
CK0913
RAILROAD MEDICARE
OH
Enumeration date
11/21/2006
Last updated
06/09/2010
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