Fred Corder Jr., PA-C
Individual provider Active NPI Physician Assistant · Coshocton, OH
NPI 1164586400 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164586400
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 50.000341 (OH)
- Practice address
- 440 Browns LN
Coshocton, OH 43812-2044 - Phone
- (740) 622-0332
- NPI assigned
- Dec 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080219000334 | OH | Practitioner - Physician Assistant | 1658454327 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50.000341 | OH | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prime Healthcare Foundation - Coshocton, LLC | Current |
Accepting new patients |
Locations
1801 W Olympic Blvd
Pasadena, CA 91199
1460 Orange St
Coshocton, OH 43812
Phone (740) 545-7919
440 Browns Ln
Coshocton, OH 43812
Phone (740) 295-3331
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 50.000341 | OH | Yes |
Addresses
Primary practice location
440 Browns LN
Coshocton, OH 43812-2044
Mailing address
946 Severn Dr
Coshocton, OH 43812-2737
Phone (740) 622-4916
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50.000341 | Other | OH | PA-C LICENSE NUMBER |
Other providers in Coshocton, OH
- Riley Conkle
- Carolyn Contonio
- Angela Copenhaver
- Steven Roy Copenhaver
- Renee Corbett
- Coshocton Anesthesia Assoc
- Coshocton Anesthesia Professionals LTD
- Coshocton Chiropractic Health Clinic
- Coshocton City Board of Education
- Coshocton County Board of MRDD
All providers in Coshocton, OH · Physician Assistant in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.