Basic Information
| Provider Information | |||||||||
| NPI: | 1225007016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOUSE | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 179 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448110179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402745000 | ||||||||
| FaxNumber: | 4407168608 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 W MCPHERSON HWY | ||||||||
| Address2: | |||||||||
| City: | CLYDE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434101133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195470584 | ||||||||
| FaxNumber: | 4195478918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 11/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34-007179 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000351615 | 01 | OH | ANTHEM | OTHER | 20711612 | 01 | OH | UNITED HEALTHCARE | OTHER | 58182 | 01 | OH | NATIONWIDE HEALTH PLAN | OTHER | P00180079 | 01 | OH | RAILROAD MEDICARE | OTHER | 04663 | 01 | OH | PARAMOUNT | OTHER | 2158472 | 05 | OH | MEDICAID |