Organization
CHARLES P HOUSE SR DO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES P HOUSE SR. DO (PRESIDENT)
(419) 547-0584
Entity
Organization
Contact information
Practice address
700 W MAPLE ST, CLYDE, OH 43410-1414
(419) 547-0584
(419) 547-8918
Mailing address
PO BOX 179, BELLEVUE, OH 44811-0179
(440) 274-5035
(440) 716-8608
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
603819300
DEPT OF LABOR
OH
01
—
DC6183
RAILROAD MEDICARE
OH
Enumeration date
03/15/2006
Last updated
02/23/2015
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