Basic Information
| Provider Information | |||||||||
| NPI: | 1043250996 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMENEMY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446222058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303437950 | ||||||||
| FaxNumber: | 3303437805 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 HOSPITAL DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446222058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303437950 | ||||||||
| FaxNumber: | 3303437805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 09/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 96-00638 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8955790 | 05 | NC | MEDICAID | 55790 | 01 | NC | BCBS | OTHER |