| Southmoor Medical Associate | |
|
38 Southmoor Cir Ne Suite B Kettering OH 45429-2443 | |
| (937) 294-4487 | |
| (937) 294-2255 |
| Full Name | Southmoor Medical Associate |
|---|---|
| Speciality | Family Medicine |
| Location | 38 Southmoor Cir Ne, Kettering, Ohio |
| Authorized Official Name and Position | Daniel D Haibach (DIRECTOR BUSINESS DEVELOPMENT) |
| Authorized Official Contact | 9375583222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southmoor Medical Associate 2110 Leiter Rd Miamisburg OH 45342-3660 Ph: (937) 384-4838 | Southmoor Medical Associate 38 Southmoor Cir Ne Suite B Kettering OH 45429-2443 Ph: (937) 294-4487 |
| NPI Number | 1568744969 |
|---|---|
| Provider Enumeration Date | 09/13/2011 |
| Last Update Date | 09/13/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568744969 | NPI | - | NPPES |
| 2712872 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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