Provider Demographics
NPI:1891947958
Name:CLINIC OF OSTEOPATHIC MEDICINE, INC
Entity Type:Organization
Organization Name:CLINIC OF OSTEOPATHIC MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-652-5512
Mailing Address - Street 1:929 ROBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-2454
Mailing Address - Country:US
Mailing Address - Phone:330-652-5512
Mailing Address - Fax:330-652-5122
Practice Address - Street 1:929 ROBBINS AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-2454
Practice Address - Country:US
Practice Address - Phone:330-652-5512
Practice Address - Fax:330-652-5122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty