Provider Demographics
NPI:1821358417
Name:FREEDA J. FLYNN, M.D.
Entity Type:Organization
Organization Name:FREEDA J. FLYNN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-695-5190
Mailing Address - Street 1:67609 WARNOCK ST CLAIRSVILLE RD
Mailing Address - Street 2:BOX 706
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9129
Mailing Address - Country:US
Mailing Address - Phone:740-695-5190
Mailing Address - Fax:740-695-5191
Practice Address - Street 1:67609 WARNOCK ST CLAIRSVILLE RD
Practice Address - Street 2:BOX 706
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9129
Practice Address - Country:US
Practice Address - Phone:740-695-5190
Practice Address - Fax:740-695-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-066409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0137971Medicaid
G00795Medicare UPIN