Provider Demographics
NPI:1699763169
Name:DENNIS A MESKER MD ET AL PTR
Entity type:Organization
Organization Name:DENNIS A MESKER MD ET AL PTR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MESKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-636-1650
Mailing Address - Street 1:1510 COLUMBUS AVE STE 230
Mailing Address - Street 2:PO BOX 548
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-0548
Mailing Address - Country:US
Mailing Address - Phone:740-636-1650
Mailing Address - Fax:740-636-2772
Practice Address - Street 1:1510 COLUMBUS AVE
Practice Address - Street 2:STE 230
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1899
Practice Address - Country:US
Practice Address - Phone:740-636-1650
Practice Address - Fax:740-636-2772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061859M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0897258Medicaid
OH0897258Medicaid
F10429Medicare UPIN