Provider Demographics
NPI:1508045329
Name:CHARLES G FELIX LLC
Entity Type:Organization
Organization Name:CHARLES G FELIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:FELIX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-885-8822
Mailing Address - Street 1:5151 S MAIN STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2153
Mailing Address - Country:US
Mailing Address - Phone:419-885-8822
Mailing Address - Fax:419-885-9221
Practice Address - Street 1:5151 S MAIN STREET
Practice Address - Street 2:SUITE D
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2153
Practice Address - Country:US
Practice Address - Phone:419-885-8822
Practice Address - Fax:419-885-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082833261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCH9358901Medicare PIN
MIOP29800Medicare PIN