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Independent Provider — NPI 1821217308, S Charleston, OH | NPI Central

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NPI 1821217308

OrganizationActive

Independent Provider

NPI 1821217308 · Exclusive Provider Organization · S Charleston, OH

Provider details

NPI number: 1821217308
Entity type: Organization
Primary specialty: Exclusive Provider OrganizationManaged Care Organizations
Organization subpart: No
Authorized official: Wendy Capper, Independent Provider(937) 324-4438
License: SK307751 (OH)

Specialties & taxonomies

Exclusive Provider OrganizationPrimary302F00000XLicense SK307751 (OH)
Managed Care Organizations
Preferred Provider Organization305R00000XLicense SK307751 (OH)
Managed Care Organizations

Practice location

2273 Newlove Rd

S Charleston, OH 45368-9732

Phone: (937) 324-4438

Approximate (ZIP-level) locationGet directions

More OH providers

Mailing address

Po Box 427

S Charleston, OH 45368-0427

Other names (DBA / former)

Doing business as: Independent Provider

Registry dates

Enumerated: 2007-04-24
Last updated: 2025-09-11

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.