Provider Demographics
NPI:1356593065
Name:HOUSE CALL MD LLC
Entity type:Organization
Organization Name:HOUSE CALL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:W
Authorized Official - Last Name:FAULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-272-9840
Mailing Address - Street 1:PO BOX 14397
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-7397
Mailing Address - Country:US
Mailing Address - Phone:330-758-2775
Mailing Address - Fax:330-758-2787
Practice Address - Street 1:150 OVERHILL RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-1455
Practice Address - Country:US
Practice Address - Phone:330-272-9840
Practice Address - Fax:330-423-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.091967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3007696Medicaid
OH35.091967OtherLICENSE
OH35.091967OtherLICENSE