| Fairfield Road Physician Office | |
|
722 N Fairfield Rd Beavercreek OH 45434-5918 | |
| (937) 208-7000 | |
| (937) 208-7010 |
| Full Name | Fairfield Road Physician Office |
|---|---|
| Speciality | Internal Medicine |
| Location | 722 N Fairfield Rd, Beavercreek, Ohio |
| Authorized Official Name and Position | Kenneth Prunier (CEO/PRESIDENT) |
| Authorized Official Contact | 9372088213 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairfield Road Physician Office 722 N Fairfield Rd Beavercreek OH 45434-5918 Ph: (937) 208-7000 | Fairfield Road Physician Office 722 N Fairfield Rd Beavercreek OH 45434-5918 Ph: (937) 208-7000 |
| NPI Number | 1124072004 |
|---|---|
| Provider Enumeration Date | 05/22/2006 |
| Last Update Date | 11/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124072004 | NPI | - | NPPES |
| 0964550 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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