Provider Demographics
NPI:1275851669
Name:EAST PALESTINE FAMILY MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:EAST PALESTINE FAMILY MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-426-2422
Mailing Address - Street 1:50410 STATE RT. #14
Mailing Address - Street 2:
Mailing Address - City:EAST PALESTINE
Mailing Address - State:OH
Mailing Address - Zip Code:44413
Mailing Address - Country:US
Mailing Address - Phone:330-426-2422
Mailing Address - Fax:330-426-2275
Practice Address - Street 1:50410 STATE RT. #14
Practice Address - Street 2:
Practice Address - City:EAST PALESTINE
Practice Address - State:OH
Practice Address - Zip Code:44413
Practice Address - Country:US
Practice Address - Phone:330-426-2422
Practice Address - Fax:330-426-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-001678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0064826Medicaid
OH0064826Medicaid
OHRI0015021Medicare PIN