Provider Demographics
NPI:1164612933
Name:CLEAR SPRINGS MEDICAL CENTER LTD
Entity Type:Organization
Organization Name:CLEAR SPRINGS MEDICAL CENTER LTD
Other - Org Name:CLEAR SPRINGS MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-857-5787
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:4774 KIDRON RD.
Mailing Address - City:KIDRON
Mailing Address - State:OH
Mailing Address - Zip Code:44636-0268
Mailing Address - Country:US
Mailing Address - Phone:330-857-5787
Mailing Address - Fax:330-857-8812
Practice Address - Street 1:4774 KIDRON RD.
Practice Address - Street 2:
Practice Address - City:KIDRON
Practice Address - State:OH
Practice Address - Zip Code:44636
Practice Address - Country:US
Practice Address - Phone:330-857-5787
Practice Address - Fax:330-857-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080282207VE0102X
OH34005514207VX0000X
OH01531367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty