Richard D Watkins Canton Community Clinic, Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

RICHARD D WATKINS CANTON COMMUNITY CLINIC, INC

Practice address

3015 Mahoning Rd NE
Canton, OH 44705-3335

Phone

(330) 454-2000

Fax

(330) 454-6184

NPI assigned

Jul 26, 2013

Organization subpart

No

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

Authorized official

Name

David Cola, DO

Title

Ceo

Phone

(330) 454-2000

Specialties & licenses 1

Addresses

Other names 1

• Mahoning Road Family Health Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 361035

Legal name

MAHONING ROAD FAMILY HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jan 17, 2014

Last certification

Jan 17, 2014

Ownership / control type

For profit – partnership

Facility address

3015 Mahoning Road
Canton, OH 44705

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

{
    "created_epoch": "1374796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405296000000",
    "number": "1619319043",
    "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": "330-454-7284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 MAHONING RD NE",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447053335",
            "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": "2013-07-26",
        "last_updated": "2014-07-14",
        "status": "A",
        "authorized_official_last_name": "COLA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "330-454-2000",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mahoning Road Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael A Rich, M.D.
• Richard a George PHD Inc
• Richard a Raabe DPM Inc
• Richard D Watkins Canton Community Clinic Inc
• Richard D Watkins Canton Community Clinic Inc.
• Richard D Watkins Canton Community Clinic, Inc.
• Brandon Andrew Richards
• Chase T Richards, B.S.SPEC. ED. M.ED.L
• Hope Richards
• Paul M Richards, DO

• Federally Qualified Health Center (FQHC) in Canton, OH
• Providers in Canton, OH by specialty
• Federally Qualified Health Center (FQHC) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.