Organization
RICHARD D WATKINS CANTON COMMUNITY CLINIC INC.
Active
Other names
Canton Community Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
PENNY A GEMBAROSKY (CHIEF FINANCIAL OFFICER)
(330) 454-2000
Entity
Organization
Contact information
Practice address
2725 LINCOLN ST E, CANTON, OH 44707-2769
(330) 454-2000
(330) 454-6184
Mailing address
2725 LINCOLN ST E, CANTON, OH 44707-2769
(330) 454-2000
(330) 454-6184
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0119875
—
OH
01
—
3619131
MEDICARE PTAN
—
Enumeration date
10/24/2006
Last updated
02/01/2008
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