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NPI Code Detail

MEDICARE: FT RECOVERY FAMILY MEDICINE, INC

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
1207Q00000XFamily 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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Directions to “FT RECOVERY FAMILY MEDICINE, INC ” Practice Location

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