Provider Demographics
NPI:1114092814
Name:CARNATION CLINIC INC
Entity Type:Organization
Organization Name:CARNATION CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RASARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-821-0201
Mailing Address - Street 1:1401 S ARCH AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4202
Mailing Address - Country:US
Mailing Address - Phone:330-821-0201
Mailing Address - Fax:330-821-1924
Practice Address - Street 1:1401 S ARCH AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4202
Practice Address - Country:US
Practice Address - Phone:330-821-0201
Practice Address - Fax:330-821-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCK0913OtherRAILROAD MEDICARE
OH0103640Medicaid
OH127480600OtherFEDERAL EMPLOYEE BWC
OH=========OtherDIRECT CARE AMERICA
OH=========OtherINTEGRATED HEALTH PLAN
OH=========OtherMAIL HANDLERS
OH=========OtherCOVENTRY HEALTH PLAN
OH=========OtherEMERALD HEALTH
OH=========OtherINTERPLAN HEALTH GROUP
OH=========OtherINTERNATIONAL INS RESOURC
OH127480600OtherFEDERAL EMPLOYEE BWC
OHCK0913OtherRAILROAD MEDICARE
OH=========OtherCIGNA
OH=========OtherFIRST HEALTH
OH=========OtherMULTIPLAN
OH=========OtherCHOICE CARE PPO
OH=========OtherGREAT WEST HEALTH
OH=========OtherPRIMARY HEALTH CARE SERVI
OH9271071Medicare PIN
OH=========OtherCIGNA