| Broadway Family Medicine Inc | |
|
1470 N Broadway St Suite100 Lebanon OH 45036-1744 | |
| (513) 932-1936 | |
| (513) 932-3105 |
| Full Name | Broadway Family Medicine Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1470 N Broadway St, Lebanon, Ohio |
| Authorized Official Name and Position | Rose Ebel (PRESIDENT) |
| Authorized Official Contact | 5139321936 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway Family Medicine Inc Po Box 4723 Belfast ME 04915-4723 Ph: (513) 932-1936 | Broadway Family Medicine Inc 1470 N Broadway St Suite100 Lebanon OH 45036-1744 Ph: (513) 932-1936 |
| NPI Number | 1083696538 |
|---|---|
| Provider Enumeration Date | 11/18/2005 |
| Last Update Date | 09/20/2018 |
| Medicare PECOS PAC ID | 5698715803 |
|---|---|
| Medicare Enrollment ID | O20050506000576 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083696538 | NPI | - | NPPES |
| CK5993 | Other | OH | RR MCR |
| 2378538 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Rose S Ebel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619950656 PECOS PAC ID: 4183692882 Enrollment ID: I20040921000401 |
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