RICHARD D WATKINS CANTON COMMUNITY CLINIC, INC (NPI# 1619319043) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619319043 |
| Entity Type | Organization |
| Organization Name | RICHARD D WATKINS CANTON COMMUNITY CLINIC, INC |
| Other Organization Name | MAHONING ROAD FAMILY HEALTH CENTER |
| Practice Address |
3015 Mahoning Rd Ne Canton OH 44705-3335 |
| Mailing Address |
2725 Lincoln St E Canton OH 44707-2769 |
| Practice Telephone | 3304542000 |
| Practice Fax Number | 3304546184 |
| Mailing Telephone | 3304542000 |
| Mailing Fax Number | 3304547284 |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2014-07-14 |
| Authorized Official Name | DAVID COLA (CEO) |
| Authorized Official Telephone | 3304542000 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Mahoning Road Family Health Center | Doing Business As Name - Organization |
| Street Address |
3015 MAHONING RD NE |
| City | CANTON |
| State | OH |
| Zip Code | 44705-3335 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609395623 | Catherine Dana Tavares | Registered Nurse | 5321 Johnnycake Ridge Ne, Canton, OH 44705 | 2017-09-11 |
| 1790168706 | Vicki T Perrin | Home Health Aide | 3033 Endrow Ave Ne, Canton, OH 44705 | 2015-07-08 |
| 1679066542 | Atlantic Dme LLC | Durable Medical Equipment & Medical Supplies | 3501 Lesh St Ne, Canton, OH 44705 | 2018-06-14 |
| 1982262432 | Ciara A Davenport | Nurse's Aide | 809 Gibbs Ave Ne, Canton, OH 44705-1009 | 2019-05-30 |
| 1952790594 | Ivory Hollamon | Home Health Aide | 1209 Lippert Rd Ne, Canton, OH 44705-1019 | 2015-01-20 |
| 1003842196 | Lana May Butcher | Home Health Aide | 1219 Lippert Rd Ne, Canton, OH 44705-1019 | 2006-06-23 |
| 1124628896 | Asia Annette Everett | Home Health Aide | 918 Rowland Ave Ne, Canton, OH 44705-1064 | 2020-10-30 |
| 1396196267 | Pennie Lynn Mathewson | Student in an Organized Health Care Education/Training Program | 1309 Lawrence Rd Ne, Canton, OH 44705-1102 | 2016-06-22 |
| 1043861982 | Ravon L. Wise | Home Health Aide | 1130 12th St Ne, Canton, OH 44705-1120 | 2019-09-23 |
| 1518412360 | Angels In Mission | In Home Supportive Care | 1043 Rowland Ave Ne, Canton, OH 44705-1166 | 2016-08-22 |
| Find all providers in zip 44705 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013034636 | Mallory Community Health | Clinic/Center | 276 Nissan Parkway, Building C, Suite 100, Canton, MS 39046 | 2007-03-26 |
| 1063419422 | Georgia Highlands Medical Services, Inc. | Clinic/Center | 220 Oakside Ln, Canton, GA 30114-6413 | 2005-06-30 |
| 1811501455 | Georgia Highlands Medical Services, Inc | Clinic/Center | 210 Oakside Ln, Canton, GA 30114-6417 | 2020-09-01 |
| 1013569847 | G A Carmichael Family Health Center, Inc. | Clinic/Center | 1668 W Peace St, Canton, MS 39046-5332 | 2019-07-11 |
| 1427593409 | Great Salt Plains Health Center | Clinic/Center | 310 E. Walnut Street, Canton, OK 73724 | 2016-12-29 |
| 1851592034 | Lifecare Family Health and Dental Center, Inc | Clinic/Center | 408 9th St Sw, Canton, OH 44707-4714 | 2007-05-29 |
| 1720289903 | Richard D Watkins Canton Community Clinic, Inc. | Clinic/Center | 2725 Lincoln St E, Canton, OH 44707-2769 | 2007-05-29 |
| 1801952809 | G A Carmichael Family Health Center Inc | Clinic/Center | 1668 West Peace Street, Canton, MS 39046 | 2006-12-28 |
| 1013964923 | Lifecare Family Health and Dental Center, Inc | Clinic/Center | 2725 Lincoln St E, Canton, OH 44707-2769 | 2006-05-27 |
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| 1639783996 | Erie County Office of Auditor | Clinic/Center | 34 Executive Dr Ste A, Norwalk, OH 44857-2490 | 2020-09-03 |
| 1083231872 | Health Partners of Western Ohio | Clinic/Center | 550 S Collett St Ste 1, Lima, OH 45805-3210 | 2020-06-29 |
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| 1205452331 | Muskingum Valley Health Centers | Clinic/Center | 58601 Marietta Rd Ste 100, Byesville, OH 43723-9452 | 2020-06-24 |
| 1336777077 | Shawnee Mental Health Center Inc | Clinic/Center | 1225 Gallia St Rm 121, Portsmouth, OH 45662-4216 | 2020-03-30 |
| 1376177303 | Erie County Office of Auditor | Clinic/Center | 1925 Hayes Ave Ste B, Sandusky, OH 44870-4737 | 2020-02-28 |
| 1407480593 | Erie County Office of Auditor | Clinic/Center | 333 Buckeye Blvd Ste B, Port Clinton, OH 43452-2475 | 2020-02-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.