RICHARD D WATKINS CANTON COMMUNITY CLINIC, INC. (NPI# 1720289903) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720289903 |
| Entity Type | Organization |
| Organization Name | RICHARD D WATKINS CANTON COMMUNITY CLINIC, INC. |
| Other Organization Name | CANTON COMMUNITY CLINIC |
| Practice Address |
2725 Lincoln St E Canton OH 44707-2769 |
| Practice Telephone | 3304542000 |
| Practice Fax Number | 3304546184 |
| Mailing Telephone | 3304542000 |
| Mailing Fax Number | 3304546184 |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2008-05-08 |
| Authorized Official Name | PENNY A GEMBAROSKY (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 3304542000 |
| 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 |
|---|---|
| CANTON COMMUNITY CLINIC | Doing Business As Name - Organization |
| Street Address |
2725 LINCOLN ST E |
| City | CANTON |
| State | OH |
| Zip Code | 44707-2769 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326007501 | Irwin Lilenfield | Family Medicine | 2725 Lincoln St E, Canton, OH 44707-2769 | 2006-03-17 |
| 1942765953 | Jodi Lynn Johnson | Nurse Practitioner | 2725 Lincoln St E, Canton, OH 44707 | 2019-02-04 |
| 1003305855 | Shakeilah Carelle Burns | Nurse Practitioner | 2725 Lincoln St E, Canton, OH 44707-2769 | 2018-05-08 |
| 1114373016 | Emily Reusser | Dentist | 2725 Lincoln St E, Canton, OH 44707-2769 | 2016-05-10 |
| 1073986873 | Kasey Mercurio | Nurse Practitioner | 2725 Lincoln St E, Canton, OH 44707-2769 | 2015-11-03 |
| 1720410194 | Michelle A Nesbitt | Dental Hygienist | 2725 Lincoln St E, Canton, OH 44707-2769 | 2013-08-07 |
| 1093073546 | Rachel Lester | Registered Nurse | 2725 Lincoln St E, Canton, OH 44707 | 2012-05-02 |
| 1932433240 | Michelle D. Husted | Counselor | 2725 Lincoln St E, Canton, OH 44707-2769 | 2009-09-21 |
| 1407012206 | Rebecca J Richards | Social Worker | 2725 Lincoln St E, Canton, OH 44707-2769 | 2008-07-31 |
| 1528227105 | Richard D Watkins Canton Community Clinic Inc | Clinic/Center | 2725 Lincoln St E, Canton, OH 44707-2769 | 2008-06-09 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649781717 | Linda Wilt | Licensed Practical Nurse | 620market Ave. S., Canton, OH 44707 | 2017-10-17 |
| 1558872622 | Michele Rose Strongoli-scott | Registered Nurse | 1620 Market Ave S., Canton, OH 44707 | 2017-10-17 |
| 1366972234 | Terri Sue Clendenin | Home Health Aide | 1317 Mattie St Sw, Canton, OH 44707 | 2017-06-14 |
| 1215467311 | Draya K Ellis | Community Health Worker | 408 9th Street Sw, Canton, OH 44707 | 2017-06-13 |
| 1720537780 | Individual | Preferred Provider Organization | 1111 Gonder Avenue Se, Canton, OH 44707 | 2016-09-30 |
| 1962958512 | Individual | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1111 Gonder Av Se, Canton, OH 44707 | 2016-09-01 |
| 1184070526 | Mj Harvey Development, LLC | Day Training, Developmentally Disabled Services | 804 Marion Ave Sw, Canton, OH 44707 | 2016-05-04 |
| 1164898516 | Erica Marie Brown | Occupational Therapy Assistant | 1620 Market Ave., South, Canton, OH 44707 | 2015-08-19 |
| 1508256439 | Kenny Mcclelland | Military/U.S. Coast Guard Transport | 903 Alan Page Dr Se # Apt1, Canton, OH 44707 | 2015-01-30 |
| 1295143550 | Susan Elaine Ball | Technician | 908 6th St Sw, Canton, OH 44707 | 2014-07-30 |
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| 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 |
|---|---|---|---|---|
| 1619319043 | Richard D Watkins Canton Community Clinic, Inc | Clinic/Center | 3015 Mahoning Rd Ne, Canton, OH 44705-3335 | 2013-07-26 |
| 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 |
| 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 |
| 1366068405 | Muskingum Valley Health Centers | Clinic/Center | 225 W Union Ave Ste 100, West Lafayette, OH 43845-1150 | 2020-06-24 |
| 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 |
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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.