MEDICARE: FT RECOVERY FAMILY MEDICINE, INC

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1588636849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FT RECOVERY FAMILY MEDICINE, INC

Provider Business Mailing Address
First Line	:	807 BLUE JACKET DRIVE
Second Line	:
City	:	FORT RECOVERY
State	:	OH
Zip	:	45846
Country	:	US
Telephone Number	:	419-375-2122
Fax Number	:	419-375-7003

Provider Business Practice Location Address
First Line	:	807 BLUE JACKET DRIVE
Second Line	:
City	:	FORT RECOVERY
State	:	OH
Zip	:	45846
Country	:	US
Telephone Number	:	419-375-2112
Fax Number	:	417-375-7003

Authorized Official
Title or Position	:	MANAGER/OWNER
Name	:	MRS. LORI A ROHRER
Credential	:
Telephone Number	:	419-375-2122

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	07/30/2008

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