Provider Demographics
NPI:1497724140
Name:CHARLES P HOUSE SR DO
Entity Type:Organization
Organization Name:CHARLES P HOUSE SR DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:419-547-0584
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-0179
Mailing Address - Country:US
Mailing Address - Phone:440-274-5035
Mailing Address - Fax:440-716-8608
Practice Address - Street 1:700 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-1414
Practice Address - Country:US
Practice Address - Phone:419-547-0584
Practice Address - Fax:419-547-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH603819300OtherDEPT OF LABOR
OHDC6183OtherRAILROAD MEDICARE
OHDC6183OtherRAILROAD MEDICARE
OH603819300OtherDEPT OF LABOR
OH603819300OtherDEPT OF LABOR