Gary R. Huston D.O., Inc
Organization Active NPI General Practice Physician · Conneaut, OH
NPI 1114299104 · NPPES record last updated Feb 6, 2012
Key facts
- NPI
- 1114299104
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 34-00-4562 (OH)
- Legal business name
- GARY R. HUSTON D.O., INC
- Practice address
- 177 West St
Conneaut, OH 44030-2153 - Phone
- (440) 593-6551
- Fax
- (440) 593-6522
- NPI assigned
- Feb 6, 2012
- Organization subpart
- No
Authorized official
- Name
- Mr. Gary Robert Huston, D.O,
- Title
- President
- Phone
- (440) 593-6551
Practitioners 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120227000643 | OH | Part B Supplier - Clinic/Group Practice | 8325096613 |
Receives reassigned benefits from 1 practitioner Practice locations: Conneaut, OH |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | 34-00-4562 | OH | Yes |
Addresses
Primary practice location
177 West St
Conneaut, OH 44030-2153
Mailing address
PO Box 635
177 West St
Conneaut, OH 44030-0635
Phone (440) 593-6551
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0772310 | Medicaid | OH |
Other providers in Conneaut, OH
- Nichole Jean Engelmann
- Es3 Management Inc.
- Trisha Mae Foltz
- Douglas K Franley
- Lisa Marie Gagich
- Christine Gaskell
- Gerdes Pharmacy Inc
- Gerdes Pharmacy Inc
- Gerdes Pharmacy Inc
- Kerry W Gerdes
All providers in Conneaut, OH · General Practice Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.