Organization Name: | PRIMECARE PHYSICIANS OF WEST CENTRAL OHIO, INC |
NPI Number: | 1609084375 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEANIE BOSSLET (PRACTICE MANAGER) |
Mailing Address: | 1205 Fairington Dr Sidney |
State: | OH US |
Postal Code: | 453658144 |
Phone Number: | 9374928431 |
Fax Number: | 9374985126 |
NPI Enumeration Date: | 05/18/2007 |
NPI Last Update Date: | 10/24/2011 |
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: |