Provider Demographics
NPI:1063685006
Name:MILLTOWN MEDICAL ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:MILLTOWN MEDICAL ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-345-8060
Mailing Address - Street 1:128 E MILLTOWN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-6109
Mailing Address - Country:US
Mailing Address - Phone:330-345-8060
Mailing Address - Fax:330-345-5983
Practice Address - Street 1:128 E MILLTOWN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-6109
Practice Address - Country:US
Practice Address - Phone:330-345-8060
Practice Address - Fax:330-345-5983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35090047171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2792018Medicaid
OHH56200Medicare UPIN