Provider Demographics
NPI:1750483152
Name:CHARLES P HOUSE SR. D.O. INC
Entity Type:Organization
Organization Name:CHARLES P HOUSE SR. D.O. INC
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:419-484-7700
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:440-716-1283
Mailing Address - Fax:440-716-1605
Practice Address - Street 1:521 N SANDUSKY ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-1180
Practice Address - Country:US
Practice Address - Phone:419-483-4495
Practice Address - Fax:419-483-7068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTRICARE
OH=========01OtherBWC
OH=========OtherTRICARE
OHDC6183Medicare ID - Type UnspecifiedRAILROAD MEDICARE