Provider Demographics
NPI:1245614536
Name:PATRIOT HOUSECALL, INC
Entity Type:Organization
Organization Name:PATRIOT HOUSECALL, INC
Other - Org Name:INDEPENDENCE VISITING PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-306-9651
Mailing Address - Street 1:986 TIBBETTS WICK RD
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1138
Mailing Address - Country:US
Mailing Address - Phone:330-980-9009
Mailing Address - Fax:330-395-0133
Practice Address - Street 1:986 TIBBETTS WICK RD
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1120
Practice Address - Country:US
Practice Address - Phone:330-306-9651
Practice Address - Fax:330-395-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty