Provider Demographics
NPI:1336220003
Name:HOMER L SKINNER & MARC S UCCHINO PTRS
Entity Type:Organization
Organization Name:HOMER L SKINNER & MARC S UCCHINO PTRS
Other - Org Name:MAIN MEDICAL FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:S
Authorized Official - Last Name:UCCHINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-482-9203
Mailing Address - Street 1:319 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408
Mailing Address - Country:US
Mailing Address - Phone:330-482-9203
Mailing Address - Fax:330-482-4407
Practice Address - Street 1:319 NORTH MAIN STREET
Practice Address - Street 2:MAIN MEDICAL FAMILY PRACTICE
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408
Practice Address - Country:US
Practice Address - Phone:330-482-9203
Practice Address - Fax:330-482-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0740318Medicaid
OH9932071Medicare ID - Type Unspecified