Healthcare Provider Details

I. General information

NPI: 1922206291
Provider Name (Legal Business Name): SOUTH COURT FAMILY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 S COURT ST SUITE 100
MEDINA OH
44256-4354
US

IV. Provider business mailing address

1075 S COURT ST SUITE 100
MEDINA OH
44256-4354
US

V. Phone/Fax

Practice location:
  • Phone: 330-722-6337
  • Fax: 330-722-0481
Mailing address:
  • Phone: 330-722-6337
  • Fax: 330-722-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35077002B
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50-002583
License Number StateOH

VIII. Authorized Official

Name: MRS. JENNIFER L HODGES
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-722-6337