Healthcare Provider Details

I. General information

NPI: 1710749114
Provider Name (Legal Business Name): SENECTUM MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 SEDGEFIELD CT
MAINEVILLE OH
45039-7513
US

IV. Provider business mailing address

PO BOX 1060
UNIONTOWN OH
44685-1060
US

V. Phone/Fax

Practice location:
  • Phone: 513-275-6551
  • Fax: 513-880-0849
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PHYLLIS J ATKINSON
Title or Position: OWNER
Credential: NP
Phone: 513-878-0907