Provider Demographics
NPI:1619179207
Name:FAUSTER CAMERON INC., DBA DEFIANCE CLINIC
Entity Type:Organization
Organization Name:FAUSTER CAMERON INC., DBA DEFIANCE CLINIC
Other - Org Name:NAPOLEON CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:PETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-784-1414
Mailing Address - Street 1:1426 N. SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-1026
Mailing Address - Country:US
Mailing Address - Phone:419-599-5500
Mailing Address - Fax:
Practice Address - Street 1:1426 N. SCOTT ST
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1026
Practice Address - Country:US
Practice Address - Phone:419-599-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0121746Medicaid
OH0121746Medicaid