Provider Demographics
NPI:1821117102
Name:FREMONT WALKIN MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:FREMONT WALKIN MEDICAL CENTER, 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:
Authorized Official - Last Name:VALONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:419-334-7191
Mailing Address - Street 1:1223 OAK HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-1020
Mailing Address - Country:US
Mailing Address - Phone:419-334-7191
Mailing Address - Fax:419-334-7405
Practice Address - Street 1:1223 OAK HARBOR RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-1020
Practice Address - Country:US
Practice Address - Phone:419-334-7191
Practice Address - Fax:419-334-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003421261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0720492Medicaid
OH9926161Medicare ID - Type Unspecified