Healthcare Provider Details

I. General information

NPI: 1114654753
Provider Name (Legal Business Name): MODERN MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 VALLEY VIEW DR
MORROW OH
45152-8089
US

IV. Provider business mailing address

5353 VALLEY VIEW DR
MORROW OH
45152-8089
US

V. Phone/Fax

Practice location:
  • Phone: 513-268-5655
  • Fax: 513-987-9588
Mailing address:
  • Phone: 513-268-5655
  • Fax: 513-987-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: JESSICA ANN FRANCISCO
Title or Position: OWNER/NURSE PRACTITIONER
Credential: APRN
Phone: 513-268-5655