Healthcare Provider Details

I. General information

NPI: 1609081314
Provider Name (Legal Business Name): STUDEBAKER FAMILY PRACTICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 MOSIER PKWY
BROOKVILLE OH
45309-1750
US

IV. Provider business mailing address

98 MOSIER PKWY
BROOKVILLE OH
45309-1750
US

V. Phone/Fax

Practice location:
  • Phone: 937-833-4103
  • Fax: 937-833-3147
Mailing address:
  • Phone: 937-833-4103
  • Fax: 937-833-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHERRI LETNER
Title or Position: OFFICE MANAGER
Credential:
Phone: 937-833-4103