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NPI Code Detail

MEDICARE: SOUTH COMMUNITY

MEDICARE: SOUTH COMMUNITY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1003211061
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH COMMUNITY
Provider Business Mailing Address
First Line : 8130 TOWSON BLVD
Second Line :
City : MIAMISBURG
State : OH
Zip : 45342-6120
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2745 S SMITHVILLE RD
Second Line :
City : KETTERING
State : OH
Zip : 45420-2668
Country : US
Telephone Number : 937-258-4246
Fax Number :
Authorized Official
Title or Position : YPH PROGRAM MANAGER
Name : MELISSA BUCK
Credential : MS, PCC-S
Telephone Number : 937-258-4246
Provider Enumeration Date : 11/01/2014
Last Update Date : 11/01/2014

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Directions to “SOUTH COMMUNITY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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