Provider Demographics
NPI:1770798696
Name:THE OAK FAMILY MEDICINE AND ACUPUNTURE, INC
Entity type:Organization
Organization Name:THE OAK FAMILY MEDICINE AND ACUPUNTURE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARKE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-271-4488
Mailing Address - Street 1:4760 RED BANK RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-1549
Mailing Address - Country:US
Mailing Address - Phone:513-271-4488
Mailing Address - Fax:513-271-4737
Practice Address - Street 1:4760 RED BANK RD STE 104
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-1549
Practice Address - Country:US
Practice Address - Phone:513-271-4488
Practice Address - Fax:513-271-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-053662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0687501Medicaid
1487711909OtherINDIV NPI FOR DR BAXTER
A17238Medicare UPIN
BA0610272Medicare ID - Type Unspecified