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Organization

INDEPENDENT PROVIDER

Active
Other names
Independent Provider
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. WENDY SUE CAPPER (INDEPENDENT PROVIDER)
(937) 324-4438
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
SK307751
OH
305R00000X
Preferred Provider Organization
SK307751
OH

Other

Enumeration date
04/24/2007
Last updated
09/11/2025
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