NPIMap

Organization Active NPI

Richard D Watkins Canton Community Clinic Inc.

Doing business as Canton Community Clinic

  • Primary Care Clinic/Center
  • Canton, OH
National Provider Identifier
1427132984
Registry record updated Feb 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
RICHARD D WATKINS CANTON COMMUNITY CLINIC INC.
Doing business as
Canton Community Clinic
Practice address
2725 Lincoln St E
Canton, OH 44707-2769
Phone
(330) 454-2000
Fax
(330) 454-6184
NPI assigned
Oct 24, 2006
Last updated
Feb 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Penny A Gembarosky
Title
Chief Financial Officer
Phone
(330) 454-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

2725 Lincoln St E
Canton, OH 44707-2769

Mailing address

2725 Lincoln St E
Canton, OH 44707-2769
Phone (330) 454-2000

Other identifiers 2

IdentifierTypeStateIssuer
0119875MedicaidOH
3619131OtherMEDICARE PTAN

Other names 1

  • Canton Community Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Canton Community Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201824000000",
    "number": "1427132984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 LINCOLN ST E",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447072769",
            "telephone_number": "330-454-2000",
            "fax_number": "330-454-6184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 LINCOLN ST E",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447072769",
            "telephone_number": "330-454-2000",
            "fax_number": "330-454-6184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD D WATKINS CANTON COMMUNITY CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2008-02-01",
        "status": "A",
        "authorized_official_last_name": "GEMBAROSKY",
        "authorized_official_first_name": "PENNY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "330-454-2000"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0119875",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "3619131",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canton Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.