Provider Demographics
NPI:1265473664
Name:THE ARTHRITIS CLINIC LLC
Entity Type:Organization
Organization Name:THE ARTHRITIS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSTETLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-855-4709
Mailing Address - Street 1:3727 FRIENDSVILLE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3727 FRIENDSVILLE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7127
Practice Address - Country:US
Practice Address - Phone:330-855-4709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069434207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG34791Medicare UPIN
OHPENDINGMedicare ID - Type Unspecified