Organization Name: | OHIO PHYSICIAN SUPPORT INC |
NPI Number: | 1063783553 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SALLY L BROOKS (PRESIDENT) |
Mailing Address: | 11427 Reed Hartman Hwy Suite 229 Blue Ash |
State: | OH US |
Postal Code: | 452412418 |
Phone Number: | 5025966939 |
Fax Number: | |
NPI Enumeration Date: | 01/16/2012 |
NPI Last Update Date: | 01/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |