Healthcare Provider Details

I. General information

NPI: 1831501584
Provider Name (Legal Business Name): DUBLIN SPRINGS PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 HOSPITAL DR
DUBLIN OH
43016-9649
US

IV. Provider business mailing address

101 S 5TH ST
LOUISVILLE KY
40202-3157
US

V. Phone/Fax

Practice location:
  • Phone: 614-717-1800
  • Fax: 614-717-1801
Mailing address:
  • Phone: 412-588-3546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GREG MILLER
Title or Position: EVO, CFO
Credential:
Phone: 412-588-3546