Provider Demographics
NPI:1871668699
Name:DENNIS C. MCCLUSKEY, M.D. & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:DENNIS C. MCCLUSKEY, M.D. & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAMPAILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-628-0677
Mailing Address - Street 1:754 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-2205
Mailing Address - Country:US
Mailing Address - Phone:330-628-0677
Mailing Address - Fax:330-628-9195
Practice Address - Street 1:754 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-2205
Practice Address - Country:US
Practice Address - Phone:330-628-0677
Practice Address - Fax:330-628-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHL2156876Medicaid
OH=========001OtherMEDICAL MUTUAL GROUP NUMB
OHL2156876Medicaid
OH9283231Medicare ID - Type UnspecifiedGROUP
OHA15459Medicare UPIN
OHL2156876Medicaid
OH=========OtherHOMETOWN GROUP NUMBER
OHE93276Medicare UPIN