PROVIDENCE MEDICAL GROUP NPI 1972533149

NPI Information

NPI: 1972533149
Provider Name: PROVIDENCE MEDICAL GROUP
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
2912 SPRINGBORO RD W
SUITE 201
DAYTON, OH
ZIP 45439
Phone: (937) 297-8999
Get Directions

PROVIDENCE MEDICAL GROUP is a family medicine in Dayton, OH. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. PROVIDENCE MEDICAL GROUP NPI is 1972533149. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2912 SPRINGBORO RD W
SUITE 201
DAYTON, OH
ZIP 45439-674
Phone: (937) 297-8999
Fax: (937) 297-4852

The provider's authorized official is Susan J Becker .
The authorized official title is Chief Operating Officer and has the following contact phone number (937) 297-8999.

The enumeration date for this NPI number is 7/4/2006 and was last updated on 10/19/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	133V00000X	Dietitian, Registered			OHIO	No
2	163WD0400X	Registered Nurse	Diabetes Educator		OHIO	No
3	207V00000X	Obstetrics & Gynecology				No
4	208000000X	Pediatrics				No
5	208600000X	Surgery				No
6	2088F0040X	Urology	Female Pelvic Medicine and Reconstructive Surgery			No
7	208C00000X	Colon & Rectal Surgery				No
8	208D00000X	General Practice				No
9	291U00000X	Clinical Medical Laboratory				No
10	363AM0700X	Physician Assistant	Medical			No
11	363L00000X	Nurse Practitioner		1313008	OHIO	No
12	363LA2100X	Nurse Practitioner	Acute Care			No
13	363LA2200X	Nurse Practitioner	Adult Health			No
14	363LP0200X	Nurse Practitioner	Pediatrics			No
15	207Q00000X	Family Medicine				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2380294	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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