Provider Demographics
NPI:1255613840
Name:TWIN SPRINGS MEDICAL CENTER LTD
Entity type:Organization
Organization Name:TWIN SPRINGS MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-857-0177
Mailing Address - Street 1:12991 EMERSON RD
Mailing Address - Street 2:PO BOX 247 KIDRON OH 44636
Mailing Address - City:APPLE CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44606-9302
Mailing Address - Country:US
Mailing Address - Phone:330-857-0177
Mailing Address - Fax:330-857-0190
Practice Address - Street 1:12991 EMERSON RD
Practice Address - Street 2:
Practice Address - City:APPLE CREEK
Practice Address - State:OH
Practice Address - Zip Code:44606-9302
Practice Address - Country:US
Practice Address - Phone:330-857-0177
Practice Address - Fax:330-857-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.05334.NM367A00000X
OHCOA.14487.NM367A00000X
OH34.010303207Q00000X
OH34-00-5514207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0156450Medicaid
OHCA0781694Medicare PIN
OH0156450Medicaid