Provider Demographics
NPI:1063849016
Name:LARRY C. BARKLEY
Entity Type:Organization
Organization Name:LARRY C. BARKLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-206-2063
Mailing Address - Street 1:9479 CABLE LINE RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND
Mailing Address - State:OH
Mailing Address - Zip Code:44412-9784
Mailing Address - Country:US
Mailing Address - Phone:330-206-2063
Mailing Address - Fax:
Practice Address - Street 1:9479 CABLE LINE RD
Practice Address - Street 2:
Practice Address - City:DIAMOND
Practice Address - State:OH
Practice Address - Zip Code:44412-9784
Practice Address - Country:US
Practice Address - Phone:330-206-2063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19090305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization