| Mt Victory Family Practice Llc | |
|
460 S Main St Mt Victory OH 43340 | |
| (937) 354-2028 | |
| (934) 354-2029 |
| Full Name | Mt Victory Family Practice Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 460 S Main St, Mt Victory, Ohio |
| Authorized Official Name and Position | Holly R Recob (PHYSICIAN) |
| Authorized Official Contact | 9373542028 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mt Victory Family Practice Llc 460 S Main St Mt Victory OH 43340 Ph: (937) 354-2028 | Mt Victory Family Practice Llc 460 S Main St Mt Victory OH 43340 Ph: (937) 354-2028 |
| NPI Number | 1245379494 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 06/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245379494 | NPI | - | NPPES |
| 0937795 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 34005413R (Ohio) | Primary |