Provider Demographics
NPI:1912076118
Name:NEW WASHINGTON MEDICAL PRACTICE
Entity Type:Organization
Organization Name:NEW WASHINGTON MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-492-2225
Mailing Address - Street 1:120 W MAIN ST
Mailing Address - Street 2:P.O. BOX 456
Mailing Address - City:NEW WASHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44854-9431
Mailing Address - Country:US
Mailing Address - Phone:419-492-2225
Mailing Address - Fax:419-492-2191
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW WASHINGTON
Practice Address - State:OH
Practice Address - Zip Code:44854-9431
Practice Address - Country:US
Practice Address - Phone:419-492-2225
Practice Address - Fax:419-492-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0884646Medicaid
OH0884646Medicaid
OHJO0706005Medicare PIN